2005 OPEN FORUM Abstracts
LOWER PERCENT OXYGEN SATURATION GOAL REDUCES INCIDENCE AND SEVERITY OF RETINOPATHY OF PREMATURITY IN VERY LOW BIRTH WEIGHT INFANTS.
Jamie Nystrom, RRT, RN; Gerald Nystrom, MD. Presbyterian Hospital of Dallas, Dallas, TX
Chow, et al reported a dramatic reduction in Retinopathy of Prematurity (ROP) and Severe (stage 3 and 4) ROP in Very Low Birth Weight (VLBW) infants ≤ 1500 grams birth weight when a policy of accepting lower % O2 saturation limits (83-85%) and avoidance of higher % O2 saturations (> 93%) was accepted in their NICU (Pediatrics 2003; 111:339-345).
We asked whether accepting lower % O2 saturations and avoidance of higher % O2 saturation would reduce the incidence and severity of ROP in our NICU.
In Oct 2004 we completed a multidisciplinary education program and standardized our % O2 saturation goals for VLBW infants ≤ 1500 grams birth weight (goal % O2 saturation 85-92% with alarm limits set at 80% and 95%). We then compared the impact of these changes on survival and incidences of ROP and severe ROP in VLBW infants we managed before and after the standardization of % O2 saturation goals in our NICU. Our data are summarized in the following table:
| 2002 | 2003 | 10/1/04 - 5/31/05 | ||||
| n | % | n | % | n | % | |
|
≤ 1500 g birth weight |
180 |
111 |
106 | |||
|
Survived |
149 |
83% |
92 |
83% |
92 |
88% |
|
Any ROP |
59 |
40% |
38 |
41% |
18 |
20% |
|
Severe ROP |
20 |
13% |
14 |
15% |
1 |
1% |
Our preliminary experience suggests that the incidence and severity of ROP can be dramatically reduced by allowing VLBW infants to be managed with lower %O2 saturation goals (85-92%) and limiting their exposure to high %O2 saturations (> 92%). This strategy was not associated with decreased survival and may have the secondary benefits of shorter duration of mechanical ventilation and lower rates of chronic lung disease.