Objective: To study the impact of an oxygen management strategy incorporating oxygen saturation (SpO2) targeting and fraction of inspired oxygen (FiO2) monitoring on the incidence of retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) and mortality.
Study design: This retrospective cohort study analyzed the incidence of any ROP, severe ROP, ROP requiring treatment (surgery and/or bevacizumab), BPD and mortality among 23 to 28 weeks gestational age infants admitted to the NICU in three epochs: Epoch 1 (2007-2010) before implementation of SpO2 histograms; Epoch 2 (2012-2014) with development of a software tool capable of generating automatic bedside SpO2 histograms; and Epoch 3 (2016-2019) with further software enhancements, incorporating simultaneous SpO2 and FiO2 measurements.
Results: During Epochs 1, 2 and 3, there were 601, 381, and 550 eligible infants, respectively, for a total of 1532 eligible infants. Mortality, any ROP, severe ROP, ROP needing treatment and BPD all showed significant downward trends across the three epochs. The adjusted odds ratio (aOR) of mortality was significantly lower in Epoch 3 compared with Epoch 1 (aOR 0.48). The aORs of any ROP and of BPD were significantly lower in Epochs 2 and 3 compared with Epoch 1 (respectively, ROP aORs 0.53 and 0.38; BPD aOR 0.43 and 0.43). The aOR of ROP needing treatment was significantly lower in Epoch 3 compared with Epoch 1 (aOR 0.43).
Conclusions: We have demonstrated improvement in rates of mortality, any ROP, ROP requiring treatment and BPD after implementation of a novel oxygen management strategy.