SpO2 and retinopathy of prematurity: state of the art

Aim: To evaluate the relationship between arterial saturation values determined by pulse oximetry in the first weeks of life on the incidence of retinopathy of prematurity (ROP). Methods: Randomized and observational studies were sought that compare the incidence of ROP in babies with high or low oxygen saturation targeting assisted by pulse oximetry. Results: Over the last 15 years, evidence from experimental models of ROP and clinical studies, albeit not randomized trials, has shown a reduction in the incidence of ROP and other neonatal morbidities when very preterm newborns were targeted to a lower level of arterial oxygen saturation during their hospitalization, particularly in the first few weeks after birth. More recent evidence from randomized controlled trials confirms that targeting to a lower vs higher level of oxygenation from birth to 36 weeks postmenstrual age (PMA) or to hospital discharge reduces the incidence of ROP requiring treatment by 50% but is correlated with higher mortality rates. Conclusion: Future randomized, controlled trials should be designed including a cohort of infants in which a more dynamic approach to saturation targeting is adopted, i.e. lower saturation levels in the first few weeks of life and higher saturation levels after the 32 weeks of PMA.