Retinopathy of Prematurity

Retinopathy of Prematurity ROP is a disease of disorganized vascular development in the immature retina which in the worst case leads to retinal detachment and blindness Risk factors include prematurity and low birth weight (<1500 grams)

Etiology of ROP Supplemental O2 has been implicated in the development of ROP Animal studies have further supported the belief that high saturations early in an infants development lead to the later development of retinopathy

Etiology of ROP (cont) In utero, the fetus has a PO2 of 22-24 mm Hg Following premature delivery, PO2 levels are substantially higher than this This hyperoxia may decrease the production of vascular growth factors arresting vascular development

Etiology of ROP (cont) As the eye develops, metabolic demands increase, requiring increased blood flow In an eye exposed to hyperoxia, the retina becomes hypoxic from lack of vascularity This retinal hypoxia may lead to pathologic vascular development of the immature retina

ROP These abnormal vessels may lead to fibrosis of the retina, or as the vessels proliferate, may result in retinal detachment To avoid this detachment and potential blindness infants undergo laser photocoagulation

Not Just ROP Previous studies which evaluated whether higher saturations later in the course of ROP could be beneficial, showed no significant impact on ROP, however… Higher O2 sats lead to a higher incidence of pneumonia and CLD

Our Goal… To limit oxygen exposure in infants < 1500 grams by: Targeting saturations of 89-94% Setting alarm limits at 85-95% O2 limits can be increased to 100% if infant in room air Protocolizing approach to desaturations