Major article
Lower Oxygen Saturation Alarm Limits Decrease the Severity of Retinopathy of Prematurity

Presented at the 31st Annual Meeting of the American Association for Pediatric Ophthalmology and Strabismus, Orlando, Florida, March 9-13, 2005.
https://doi.org/10.1016/j.jaapos.2006.04.010Get rights and content

Purpose

To determine whether lowering oxygen saturation alarm limits for infants at risk for retinopathy of prematurity (ROP) reduces its incidence and/or severity.

Methods

Oximetry alarm limits were lowered to 85% and 93% for all infants with a birth weight 1250 g or less and/or gestational age 28 weeks or less, and maintained until 32 weeks’ postmenstrual age or until oxygen saturations were consistently greater than 93% in room air. The new policy was effective for infants born on or after June 1, 2003. ROP data were prospectively collected, and we compared the rate and severity of ROP in the year after the oximeter alarm policy change to the rates in the immediately preceding 3 years.

Results

In the year after the oximeter alarm limit policy change, 4 of 72 infants developed prethreshold ROP compared with 44 of 251 infants in the previous 3-year epoch (17.5% vs 5.6%, p = 0.01). Similarly, only 6 of 144 eyes developed prethreshold ROP in the year after the policy change, compared with 84 of 502 in the previous 3 years (16.7% vs 4.2%, p = 0.001).

Conclusions

A simple change in oximeter alarm parameters in the first weeks of life for infants with a birth weight 1250 g or less may decrease the incidence of prethreshold ROP.

Section snippets

Methods

Before June 1, 2003, oxygen saturation alarm limits at the Brigham and Women’s Hospital NICU were set at 87% and 97% for all infants, without a specified target range. Oximetry alarm limits were lowered on June 1, 2003, to 85% and 93% for infants with a birth weight 1250 g or less and/or gestational age 28 weeks or less. Target oxygen saturations were set at 90% to 92%. All infants were monitored throughout the study period using the same oximetry technology (Masimo®; Masimo Corp., Irvine, CA).

Results

Table 1 shows the number of eligible infants per study year. Mean gestational age at birth and birth weight were similar across the years studied. The overall mean gestational age for the group with higher alarm limits was the same (27.3 weeks) as the mean gestational age for the group with lower alarm limits (27.3 weeks). The mean birth weights were also similar for the two groups (919 g vs 945 g, p = 0.43), and the proportion of screened infants with a birth weight less than 1000 g did not vary

Discussion

Oxygen administration is a necessary therapy for VLBW infants, but the optimal and safest level of oxygen saturation is unknown. NICU policies on oxygen administration, oximetry alarm settings, and monitoring vary widely. Many NICUs attempt to target oxygen saturations of 90% to 95%, with lower alarm limits set as low as 75%, and upper limits as high as 100%.7 Our NICU policy did not fall at either end of this spectrum, and we instituted only a small change in a select group of patients. Our

References (14)

  • W.A. Silverman

    A cautionary tale about supplemental oxygen: the albatross of neonatal medicine

    Pediatrics

    (2004)
  • V.E. Kinsey

    Retrolental fibroplasia. Cooperative Study of Retrolental Fibroplasia and the Use of Oxygen

    Arch Ophthalmol

    (1956)
  • M. Avery et al.

    Recent increase in mortality in hyaline membrane disease

    J Pediatr

    (1960)
  • Chow LC, Wright KW, Sola A, et al. Can changes in clinical practice decrease the incidence of severe retinopathy of...
  • S. Sun

    Relation of target SpO2 levels and clinical outcome in ELBW infants in supplemental oxygen

    Pediatr Res

    (2002)
  • W. Tin et al.

    Pulse oximetry, severe retinopathy, and outcome at one year in babies of less than 28 weeks gestation

    Arch Dis Child Fetal Neonatal Ed

    (2001)
  • C.G. Anderson et al.

    Retinopathy of prematurity and pulse oximetry: a national survey of recent practices

    J Perinatol

    (2002)
There are more references available in the full text version of this article.

Cited by (97)

  • Extremely Low-Birth-Weight Infants

    2018, Avery's Diseases of the Newborn: Tenth Edition
  • Advances in understanding and management of retinopathy of prematurity

    2017, Survey of Ophthalmology
    Citation Excerpt :

    These observations support the hypothesis put forth by Ashton14 in the 1950s that avascular retina becomes hypoxic after a preterm infant is moved from high supplemental oxygen to room air and that the ensuing retinal hypoxia triggers the release of angiogenic factors that cause aberrant intravitreal vasoproliferation. Studies reported many different angiogenic factors induce intravitreal vasoproliferation, including vascular endothelial growth factor (VEGF13), placental growth factor,156 insulin-like growth factor–1 (IGF-1180), or erythropoietin (EPO),32 as examples. In the individual preterm infant, however, precise phases do not occur as they do in experimental OIR models, and a concern exists that inhibiting angiogenesis to treat vasoproliferation might lead to avascular retina that would continue to stimulate unwanted vasoproliferation.33

  • Extremely Low-Birth-Weight Infants

    2017, Avery's Diseases of the Newborn, Tenth Edition
View all citing articles on Scopus
View full text