Abstract
Objective The use of supplemental oxygen in premature infants is essential for survival. However,
its use has been associated with unintended complications. The restricted use of oxygen
is associated with increased mortality and necrotizing enterocolitis (NEC), whereas
its liberal use is associated with increased risk for retinopathy of prematurity (ROP).
Although there is no clear consensus on the acceptable oxygen saturation range, clinicians
have recently become more liberal with the use of oxygen. We aim to assess (1) the
national trends for ROP in very low birth weight preterm infants, and (2) the associated
trends in mortality, NEC, intraventricular hemorrhage (IVH), and length of hospital
stay (LOS).
Study Design We analyzed deidentified patient data from the National Inpatient Sample (NIS) of
the Healthcare Cost and Utilization Project (HCUP) from 2002 to 2017. All infants
with gestational age ≤32 weeks and birth weight <1,500 g were included. Trends in
ROP, severe ROP, mortality, NEC, IVH, severe IVH, and LOS were analyzed using Jonckheere–Terpstra
test.
Results A total of 818,945 neonates were included in the study. The overall mortality was
16.2% and the prevalence of ROP was 17.5%. There was a significant trend for increased
ROP over the years (p < 0.001). Severe ROP was also significantly increased (p < 0.001). This was associated with a significant trend for increased median LOS in
survived infants (p < 0.001). Mortality was significantly decreased (p < 0.001), whereas NEC and severe NEC did not change over time (p = 0.222 and p = 0.412, respectively).
Conclusion There is a national trend for increased ROP and severe ROP over the 16 years of the
study period. This trend was associated with a significant increase in the LOS in
survived infants without change in NEC.
Key Points
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Prevalence of ROP and severe ROP has increased in VLBW infants over the 16-year study
period.
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The prevalence of NEC did not change over the same time period.
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Increased ROP and severe ROP were consistent in all three GA and BW subgroups.
Keywords
ROP - premature infants - targeted oxygen saturation
