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PEDIATRICS Vol. 110 No. 3 September 2002, pp. 540-544

Retinopathy of Prematurity Outcome in Infants With Prethreshold Retinopathy of Prematurity and Oxygen Saturation >94% in Room Air: The High Oxygen Percentage in Retinopathy of Prematurity Study

Mary Lou McGregor, MD*, Don L. Bremer, MD*, Cynthia Cole, MD, MPH{ddagger}, Richard E. McClead, MD, MHA§, Dale L. Phelps, MD||, Rae R. Fellows, MEd* and Neal Oden, PhD on behalf of the HOPE-ROP Multicenter Groupa

* Department of Ophthalmology, The Ohio State University, Columbus, Ohio
{ddagger} Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts
§ Department of Pediatrics, The Ohio State University, Columbus, Ohio
|| Departments of Pediatrics and Ophthalmology, University of Rochester, Rochester, New York
The EMMES Corporation, Rockville, Maryland

--> Objectives. To determine the rate of progression from prethreshold to threshold retinopathy of prematurity (ROP) in infants excluded from Supplemental Therapeutic Oxygen for Prethreshold Retinopathy of Prematurity (STOP-ROP) because their median arterial oxygen saturation by pulse oximetry (SpO2) values were >94% in room air at the time of prethreshold diagnosis and to compare them with infants who were enrolled in STOP-ROP and had median SpO2 <=94% in room air.

Methods. Fifteen of the 30 centers that participated in STOP-ROP elected to participate in the High Oxygen Percentage in Retinopathy of Prematurity study (HOPE-ROP) from January 1996 to March 1999. Infants were followed prospectively from the time prethreshold ROP was diagnosed until ROP either progressed to threshold in at least 1 study eye (adverse outcome) or resolved (favorable outcome).

Results. A total of 136 HOPE-ROP infants were compared with 229 STOP-ROP infants enrolled during the same time period from the same 15 hospitals. HOPE-ROP infants were of greater gestational age at birth (26.2 ± 1.8 vs 25.2 ± 1.4 weeks) and greater postmenstrual age at the time of prethreshold ROP diagnosis (36.7 ± 2.5 vs 35.4 ± 2.5 weeks). HOPE-ROP infants progressed to threshold ROP 25% of the time compared with 46% of STOP-ROP infants. After gestational age, race, postmenstrual age at prethreshold diagnosis, zone 1 disease, and plus disease at prethreshold diagnosis were controlled for, logistic regression analysis showed that HOPE-ROP infants progressed from prethreshold to threshold ROP less often than STOP-ROP infants (odds ratio: 0.607; 95% confidence interval: 0.359–1.026).

Conclusions. The mechanisms that result in better ROP outcome for HOPE-ROP versus STOP-ROP are not fully understood. It seems that an infant’s SpO2 value at the time of prethreshold diagnosis is a prognostic indicator for which infants may progress to severe ROP. When other known prognostic indicators are factored in, the SpO2 is of borderline significance.

Key Words: retinopathy of prematurity • retinal neovascularization • oxygen inhalation therapy • gestational age • disease progression

Abbreviations: ROP, retinopathy of prematurity • CRYO-ROP, Multicenter Trial of Cryotherapy for Retinopathy of Prematurity • PMA, postmenstrual age • STOP-ROP, Supplemental Therapeutic Oxygen for Prethreshold Retinopathy of Prematurity • SpO2, arterial oxygen saturation by pulse oximetry • HOPE-ROP, High Oxygen Percentage Retinopathy of Prematurity • OR, odds ratio • CI, confidence interval

Received for publication Sep 18, 2001; Accepted Mar 7, 2002.


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