Peer-reviewed article
Oxygen Saturation Targeting and Retinopathy Management in Very Preterm Neonates: An International Survey.
Darlow BA, Hurrion EM, Battin M, Norman M, Adams M et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This international survey examines how 382 neonatal intensive care units across 12 high-income countries and 1 middle-income country manage oxygen levels and retinopathy of prematurity in very premature infants. The study found considerable variation in oxygen saturation targets between units, with most targeting between 89-95%, and widespread use of anti-VEGF medications to treat retinopathy. Few units use automated oxygen adjustment systems despite their potential benefits. The researchers note that this variation in clinical practices may affect outcomes but more research is needed to understand these links.
Key points
- Median oxygen saturation targets were 95% upper and 89% lower, with 18% of units targeting ≥96% and 13% targeting ≤85%
- Only 24% of neonatal units used automated systems for controlled oxygen delivery
- 78% of units used a combination of birthweight and gestational age as criteria for retinopathy screening
- Anti-VEGF agents were used in all participating networks and by 76% of individual units to treat retinopathy of prematurity
- Limited change in oxygen saturation targets occurred between 2015 and 2023 despite available evidence
Limitations
This survey describes current practices but does not measure clinical outcomes or patient safety effects. The document does not explain why variation exists or which approaches are most effective for reducing harm in very premature infants.
Abstract
Introduction Variation in the uptake of evidence-based practices and adoption of unproven therapies by neonatal intensive care units (NICUs) might contribute to clinical variability. The objective was to survey current oxygen saturation targets (SpO2), the use of automatic adjustment of inspired oxygen in infants on respiratory support, the criteria for routine retinal examinations for retinopathy of prematurity (ROP), and the use of anti-vascular endothelial growth factor (VEGF) agents to treat ROP in the International Network for Evaluating Outcomes for Neonates (iNeo). Methods Online pre-piloted anonymous questionnaires on care practices in 2023 for extremely preterm (<29 weeks) infants were sent to the directors of 608 NICUs in the iNeo. Four questions concerned ROP management and results were compared with a similar 2015 survey. Results There were 11 participating networks from 12 high-income countries and one from a middle-income country. The overall NICU response rate was 63% (382 units). Despite variability between NICUs, within networks, there was limited change in SpO2 targets between 2015 and 2023. The median upper and lower SpO2 targets were 95% and 89%; in 18% of NICUs, the upper target was ≥96%, and in 13%, the lower target was ≤85%. Automated loop systems for controlled oxygen delivery were used in 24% of NICUs. Most NICUs (78%) used a combination of birthweight and gestation as ROP screening criteria. Intravitreal anti-VEGF agents were used to treat ROP in all networks and by 76% of NICUs. Discussion There was considerable variation in care practices between NICUs, and the relationship of this to clinical outcomes should be explored.