Changes in institutional oxygen saturation targets are associated with an increased rate of severe retinopathy of prematurity

PURPOSE To evaluate the effect of changes in institutional peripheral oxygen saturation (SpO(2)) targets, made in response to recent randomized trials, on risk of developing severe retinopathy of prematurity (ROP). METHODS This study was a secondary analysis of data from 21 North American hospitals during the periods 2006-2012 and 2015-2017. Hospitals were categorized based on whether or not SpO(2) targets were increased between the two study periods. Severe ROP (type 1, type 2, or zone III stage 3 +) rates were compared within and between groups. Generalized mixed effect models with random intercepts were used to account for within-center clustering and to calculate odds ratios (aOR) adjusted by birth weight (BW) and gestational age (GA), using patient-level data. RESULTS A total of 8,142 infants underwent ROP examinations at 21 hospitals during the two study periods: 5,716 in 2006-2012 (mean BW, 1109 +/- 369 g; GA, 28.0 +/- 2.6; 11.6% severe ROP); 2,426 in 2015-2017 (mean BW, 1086 +/- 347 g; GA, 28.0 +/- 2.8; 12.8% severe ROP). Fourteen hospitals increased SpO(2) targets, and 7 hospitals did not. Hospitals that increased targets had a 3% increase in severe ROP (from 12% to 15%; aOR = 1.25; 95% CI, 1.01-1.55; P = 0.044); hospitals without SpO(2) changes had a 2% decrease (from 11% to 9%; aOR = 0.72; 95% CI, 0.52-1.00; P = 0.049). The difference in change of severe ROP between groups of hospitals was significant (P = 0.005). CONCLUSIONS Increases in institutional SpO(2) targets in response to recent randomized trials were associated with increased severe ROP. Hospitals considering increasing their SpO(2) targets should anticipate increases in rates of severe ROP and manage screening and treatment resources accordingly.