Achieved oxygen saturations and retinopathy of prematurity in extreme preterms

Marie G Gantz, Waldemar A Carlo, Neil N Finer, Wade Rich, Roger G Faix, Bradley A Yoder, Michele C Walsh, Nancy S Newman, Abbott Laptook, Kurt Schibler, Abhik Das, Rosemary D Higgins, SUPPORT Study Group of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Alan H Jobe, Michael S Caplan, William Oh, Betty R Vohr, Angelita M Hensman, Bonnie E Stephens, Barbara Alksninis, Dawn Andrews, Kristen Angela, Susan Barnett, Bill Cashore, Melinda Caskey, Kim Francis, Dan Gingras, Regina A Gargus, Katharine Johnson, Shabnam Lainwala, Theresa M Leach, Martha R Leonard, Sarah Lillie, Kalida Mehta, James R Moore, Lucy Noel, Suzy Ventura, Rachel V Walden, Victoria E Watson, Avroy A Fanaroff, Deanne E Wilson-Costello, Bonnie S Siner, Arlene Zadell, Julie Difiore, Monika Bhola, Harriet G Friedman, Gulgun Yalcinkaya, Edward F Donovan, Vivek Narendran, Kimberly Yolton, Kate Bridges, Barbara Alexander, Cathy Grisby, Marcia Worley Mersmann, Holly L Mincey, Jody Hessling, Teresa L Gratton, Ronald N Goldberg, C Michael Cotten, Ricki F Goldstein, Patricia Ashley, Kathy J Auten, Kimberley A Fisher, Katherine A Foy, Sharon F Freedman, Kathryn Gustafson, Melody B Lohmeyer, William F Malcolm, David K Wallace, Barbara J Stoll, Susie Buchter, Anthony J Piazza, David P Carlton, Ira Adams-Chapman, Linda Black, Ann M Blackwelder, Sheena Carter, Elisabeth Dinkins, Sobha Fritz, Ellen C Hale, Amy K Hutchinson, Maureen Mulligan Larossa, Gloria V Smikle, Stephanie Wilson Archer, Brenda B Poindexter, Anna M Dusick, James A Lemons, Leslie D Wilson, Faithe Hamer, Ann B Cook, Dianne E Herron, Carolyn Lytle, Heike M Minnich, Kathleen A Kennedy, Jon E Tyson, Patricia W Evans, Nora I Alaniz, Patricia Evans, Beverly Foley Harris, Charles Green, Margarita Jiminez, Anna E Lis, Sarah Martin, Georgia E Mcdavid, Brenda H Morris, Margaret L Poundstone, Stacy Reddoch, Saba Siddiki, Patti L Pierce Tate, Laura L Whitely, Sharon L Wright, Mary Anne Berberich, Carol J Blaisdell, Dorothy B Gail, James P Kiley, W Kenneth Poole, Lisa A Wrage, Jamie E Newman, Betty K Hastings, Jeanette O'donnell Auman, Carolyn Petrie Huitema, James W Pickett Ii, Dennis Wallace, Kristin M Zaterka-Baxter, Krisa P Van Meurs, David K Stevenson, Susan R Hintz, M Bethany Ball, Barbara Bentley, Elizabeth F Bruno, Alexis S Davis, Maria Elena Deanda, Anne M Debattista, Jean G Kohn, Melinda S Proud, Renee P Pyle, Nicholas H St John, Hali E Weiss, Ivan D Frantz Iii, Elisabeth C Mcgowan, John M Fiascone, Anne Furey, Brenda L Mackinnon, Ellen Nylen, Ana Brussa, Cecelia Sibley, Namasivayam Ambalavanan, Myriam Peralta-Carcelen, Monica V Collins, Shirley S Cosby, Vivien A Phillips, Kirstin J Bailey, Fred J Biasini, Maria Hopkins, Kristen C Johnston, Sara Krzywanski, Kathleen G Nelson, Cryshelle S Patterson, Richard V Rector, Leslie Rodriguez, Amanda Soong, Sally Whitley, Sheree York, Maynard R Rasmussen, Paul R Wozniak, Yvonne E Vaucher, Kathy Arnell, Rene Barbieri-Welge, Ayala Ben-Tall, Renee Bridge, Clarence Demetrio, Martha G Fuller, Elaine Ito, Meghan Lukasik, Deborah Pontillo, Donna Posin, Cheryl Runyan, James Wilkes, Paul Zlotnik, Edward F Bell, John A Widness, Michael J Acarregui, Jonathan M Klein, Tarah T Colaizy, Karen J Johnson, Diane L Eastman, Shahnaz Duara, Charles R Bauer, Ruth Everett-Thomas, Maria Calejo, Alexis N Diaz, Silvia M Frade Eguaras, Andrea Garcia, Kasey Hamlin-Smith, Michelle Harwood Berkowits, Sylvia Hiriart-Fajardo, Elaine O Mathews, Helina Pierre, Arielle Riguard, Alexandra Stroerger, Kristi L Watterberg, Robin K Ohls, Janell Fuller, Julie Rohr, Conra Backstrom Lacy, Jean Lowe, Rebecca Montman, Dale L Phelps, Nirupama Laroia, Gary David Markowitz, Gary J Myers, Linda J Reubens, Diane Hust, Lisa Augostino, Julie Babish Johnson, Erica Burnell, Rosemary L Jensen, Emily Kushner, Joan Merzbach, Kelley Yost, Pablo J Sánchez, Charles R Rosenfeld, Walid A Salhab, Roy J Heyne, Sally S Adams, James Allen, Laura Grau, Alicia Guzman, Gaynelle Hensley, Elizabeth T Heyne, Melissa H Lepps, Linda A Madden, Melissa Martin, Nancy A Miller, Janet S Morgan, Araceli Solis, Lizette E Torres, Catherine Twell Boatman, Diana M Vasil, Kerry Wilder, Anna Bodnar, Shawna Baker, Karie Bird, Jill Burnett, Laura Cole, Karen A Osborne, Cynthia Spencer, Mike Steffens, Kimberlee Weaver-Lewis, Karen Zanetti, T Michael O'Shea, Robert G Dillard, Lisa K Washburn, Nancy J Peters, Barbara G Jackson, Korinne Chiu, Deborah Evans Allred, Donald J Goldstein, Raquel Halfond, Carroll Peterson, Ellen L Waldrep, Cherrie D Welch, Melissa Whalen Morris, Gail Wiley Hounshell, Seetha Shankaran, Beena G Sood, Athina Pappas, Rebecca Bara, Elizabeth Billian, Laura A Goldston, Mary Johnson, Richard A Ehrenkranz, Vineet Bhandari, Harris C Jacobs, Pat Cervone, Patricia Gettner, Monica Konstantino, Joann Poulsen, Janet Taft, Christine G Butler, Nancy Close, Walter Gilliam, Sheila Greisman, Elaine Romano, Joanne Williams, Marie G Gantz, Waldemar A Carlo, Neil N Finer, Wade Rich, Roger G Faix, Bradley A Yoder, Michele C Walsh, Nancy S Newman, Abbott Laptook, Kurt Schibler, Abhik Das, Rosemary D Higgins, SUPPORT Study Group of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Alan H Jobe, Michael S Caplan, William Oh, Betty R Vohr, Angelita M Hensman, Bonnie E Stephens, Barbara Alksninis, Dawn Andrews, Kristen Angela, Susan Barnett, Bill Cashore, Melinda Caskey, Kim Francis, Dan Gingras, Regina A Gargus, Katharine Johnson, Shabnam Lainwala, Theresa M Leach, Martha R Leonard, Sarah Lillie, Kalida Mehta, James R Moore, Lucy Noel, Suzy Ventura, Rachel V Walden, Victoria E Watson, Avroy A Fanaroff, Deanne E Wilson-Costello, Bonnie S Siner, Arlene Zadell, Julie Difiore, Monika Bhola, Harriet G Friedman, Gulgun Yalcinkaya, Edward F Donovan, Vivek Narendran, Kimberly Yolton, Kate Bridges, Barbara Alexander, Cathy Grisby, Marcia Worley Mersmann, Holly L Mincey, Jody Hessling, Teresa L Gratton, Ronald N Goldberg, C Michael Cotten, Ricki F Goldstein, Patricia Ashley, Kathy J Auten, Kimberley A Fisher, Katherine A Foy, Sharon F Freedman, Kathryn Gustafson, Melody B Lohmeyer, William F Malcolm, David K Wallace, Barbara J Stoll, Susie Buchter, Anthony J Piazza, David P Carlton, Ira Adams-Chapman, Linda Black, Ann M Blackwelder, Sheena Carter, Elisabeth Dinkins, Sobha Fritz, Ellen C Hale, Amy K Hutchinson, Maureen Mulligan Larossa, Gloria V Smikle, Stephanie Wilson Archer, Brenda B Poindexter, Anna M Dusick, James A Lemons, Leslie D Wilson, Faithe Hamer, Ann B Cook, Dianne E Herron, Carolyn Lytle, Heike M Minnich, Kathleen A Kennedy, Jon E Tyson, Patricia W Evans, Nora I Alaniz, Patricia Evans, Beverly Foley Harris, Charles Green, Margarita Jiminez, Anna E Lis, Sarah Martin, Georgia E Mcdavid, Brenda H Morris, Margaret L Poundstone, Stacy Reddoch, Saba Siddiki, Patti L Pierce Tate, Laura L Whitely, Sharon L Wright, Mary Anne Berberich, Carol J Blaisdell, Dorothy B Gail, James P Kiley, W Kenneth Poole, Lisa A Wrage, Jamie E Newman, Betty K Hastings, Jeanette O'donnell Auman, Carolyn Petrie Huitema, James W Pickett Ii, Dennis Wallace, Kristin M Zaterka-Baxter, Krisa P Van Meurs, David K Stevenson, Susan R Hintz, M Bethany Ball, Barbara Bentley, Elizabeth F Bruno, Alexis S Davis, Maria Elena Deanda, Anne M Debattista, Jean G Kohn, Melinda S Proud, Renee P Pyle, Nicholas H St John, Hali E Weiss, Ivan D Frantz Iii, Elisabeth C Mcgowan, John M Fiascone, Anne Furey, Brenda L Mackinnon, Ellen Nylen, Ana Brussa, Cecelia Sibley, Namasivayam Ambalavanan, Myriam Peralta-Carcelen, Monica V Collins, Shirley S Cosby, Vivien A Phillips, Kirstin J Bailey, Fred J Biasini, Maria Hopkins, Kristen C Johnston, Sara Krzywanski, Kathleen G Nelson, Cryshelle S Patterson, Richard V Rector, Leslie Rodriguez, Amanda Soong, Sally Whitley, Sheree York, Maynard R Rasmussen, Paul R Wozniak, Yvonne E Vaucher, Kathy Arnell, Rene Barbieri-Welge, Ayala Ben-Tall, Renee Bridge, Clarence Demetrio, Martha G Fuller, Elaine Ito, Meghan Lukasik, Deborah Pontillo, Donna Posin, Cheryl Runyan, James Wilkes, Paul Zlotnik, Edward F Bell, John A Widness, Michael J Acarregui, Jonathan M Klein, Tarah T Colaizy, Karen J Johnson, Diane L Eastman, Shahnaz Duara, Charles R Bauer, Ruth Everett-Thomas, Maria Calejo, Alexis N Diaz, Silvia M Frade Eguaras, Andrea Garcia, Kasey Hamlin-Smith, Michelle Harwood Berkowits, Sylvia Hiriart-Fajardo, Elaine O Mathews, Helina Pierre, Arielle Riguard, Alexandra Stroerger, Kristi L Watterberg, Robin K Ohls, Janell Fuller, Julie Rohr, Conra Backstrom Lacy, Jean Lowe, Rebecca Montman, Dale L Phelps, Nirupama Laroia, Gary David Markowitz, Gary J Myers, Linda J Reubens, Diane Hust, Lisa Augostino, Julie Babish Johnson, Erica Burnell, Rosemary L Jensen, Emily Kushner, Joan Merzbach, Kelley Yost, Pablo J Sánchez, Charles R Rosenfeld, Walid A Salhab, Roy J Heyne, Sally S Adams, James Allen, Laura Grau, Alicia Guzman, Gaynelle Hensley, Elizabeth T Heyne, Melissa H Lepps, Linda A Madden, Melissa Martin, Nancy A Miller, Janet S Morgan, Araceli Solis, Lizette E Torres, Catherine Twell Boatman, Diana M Vasil, Kerry Wilder, Anna Bodnar, Shawna Baker, Karie Bird, Jill Burnett, Laura Cole, Karen A Osborne, Cynthia Spencer, Mike Steffens, Kimberlee Weaver-Lewis, Karen Zanetti, T Michael O'Shea, Robert G Dillard, Lisa K Washburn, Nancy J Peters, Barbara G Jackson, Korinne Chiu, Deborah Evans Allred, Donald J Goldstein, Raquel Halfond, Carroll Peterson, Ellen L Waldrep, Cherrie D Welch, Melissa Whalen Morris, Gail Wiley Hounshell, Seetha Shankaran, Beena G Sood, Athina Pappas, Rebecca Bara, Elizabeth Billian, Laura A Goldston, Mary Johnson, Richard A Ehrenkranz, Vineet Bhandari, Harris C Jacobs, Pat Cervone, Patricia Gettner, Monica Konstantino, Joann Poulsen, Janet Taft, Christine G Butler, Nancy Close, Walter Gilliam, Sheila Greisman, Elaine Romano, Joanne Williams

Abstract

Objective: To identify achieved oxygen saturations (SpO2) associated with increased risk of severe retinopathy of prematurity (ROP).

Design: This is a secondary analysis of the Surfactant Positive Airway Pressure and Pulse Oximetry Trial (SUPPORT)randomised controlled trial. SpO2 was recorded up to 36 weeks' postmenstrual age. Saturations through 9 postnatal weeks were explored graphically, and logistic regression models were created to predict severe ROP.

Setting: 20 centres of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.

Patients: 984 surviving infants of 24-27 weeks' gestational age born in 2005-2009.

Interventions: SUPPORT targeted SpO2 to a lower (85%-89%) or higher (91%-95%) range through 36 weeks' postmenstrual age or off respiratory support.

Main outcome measures: Severe ROP defined as threshold ROP, ophthalmological surgery or bevacizumab treatment.

Results: There were statistically significant interactions between duration of oxygen supplementation and percentage of time in certain achieved saturation ranges. Specifically, for infants who spent at least 2 weeks on oxygen in postnatal weeks 1-5, a higher percentage of time at 91%-96% SpO2 was associated with increased odds of severe ROP. For infants who spent at least 3 weeks on oxygen in postnatal weeks 6-9, a higher percentage of time at 97%-100% SpO2 was associated with increased odds of severe ROP. Other significant risk factors were lower gestational age and birth weight, non-Hispanic white versus black race, prospectively defined severe illness, late-onset sepsis or meningitis, and clinical centre.

Conclusions: Among extremely preterm survivors to discharge, the association between SpO2 and severe ROP depended on the timing and duration of oxygen supplementation.

Keywords: neonatology; ophthalmology; respiratory.