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  • Clinical Research Article
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The impact of intermittent hypoxemia on type 1 retinopathy of prematurity in preterm infants

Pediatric Research (2024)Cite this article

Abstract

Background

Intermittent hypoxemia (IH) may influence retinopathy of prematurity (ROP) development in preterm infants, however, previous studies had mixed results. This study tests the hypothesis that increased IH is associated with Type 1 ROP; a stage beyond which treatment is indicated.

Methods

IH was quantified by continuously monitoring oxygen saturation (SpO2) using high-resolution pulse oximeters during the first 10 weeks of life. Statistical analyses assessed the relationship and predictive ability of weekly and cumulative IH for Type 1 ROP development.

Results

Most analyses showed no association between IH and Type 1 ROP adjusting for gestational age (GA) and birth weight (BW). However, cumulative IH of longer duration during weeks 5–10, 6–10, and 7–10 were significantly associated with Type 1 ROP adjusting for GA and BW, e.g., the adjusted odds ratio of Type 1 ROP was 2.01 (p = 0.03) for every 3.8 seconds increase in IH duration from week 6–10. IH did not provide statistically significant added predictive ability above GA and BW.

Conclusions

For most analyses there was no significant association between IH and Type 1 ROP adjusting for GA and BW. However, infants with longer IH duration during the second month of life had higher risk for Type 1 ROP.

Impact

  • The relationship and predictive ability of intermittent hypoxemia (IH) on retinopathy of prematurity (ROP) is controversial.

  • This study shows no significant association between IH events and Type 1 ROP after adjusting for gestational age (GA) and birth weight (BW), except for cumulative IH of longer duration in the second month of life.

  • In this cohort, IH does not provide a statistically significant improvement in ROP prediction over GA and BW.

  • This study is the first to assess the cumulative impact of IH measures on Type 1 ROP. Interventions for reducing IH duration during critical postnatal periods may improve ROP outcomes.

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Fig. 1: Weekly data analysis results.
Fig. 2: Cumulative process #1 results.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

We thank the research coordinators and research staff for assisting with subject enrollment and data collection. Special thank you to Sara Butler, RN, CCCE, and Crystal Wilson, LPN.

Funding

G.Y. was supported by National Institutes of Health (NIH) R01-EB028792, R01-HD101508,R21-HD091118, R21-NS114771, R41-NS122722, R56-NS117587, R01-AG062480. E.G.A wassupported by the National Center for Advancing Translational Sciences (UL1TR001998), NIHK23HD109471, and the University of Kentucky College of Medicine Dean’s Office. The contentis solely the responsibility of the authors and does not necessarily represent the official views of the NIH or University of Kentucky.

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Authors and Affiliations

  1. Department of Biomedical Engineering, University of Kentucky, Lexington, Kentucky, USA

    Samaneh Rabienia Haratbar, Dara Singh, Faraneh Fathi, Mehrana Mohtasebi, Xuhui Liu, Abhijit Patwardhan & Guoqiang Yu

  2. Biostatistics and Bioinformatics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA

    Li Chen

  3. Institute for Biomedical Informatics, Department of Internal Medicine and Department of Computer Science, Lexington, Kentucky, USA

    Qiang Cheng

  4. Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, Kentucky, USA

    Prasad Bhandary, Henrietta S. Bada & Elie G. Abu Jawdeh

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  1. Samaneh Rabienia Haratbar
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Contributions

E.G.A., G.Y., H.S.B and S.R.H. conceived the study. E.G.A. conducted and supervised human experiments. E.G.A. and P.B. acquired data. S.R.H. and L.C. analyzed and interpreted data. S.R.H and L.C. performed statistical analysis. E.G.A, P.B. and H.S.B provided resources for human experiments. S.R.H. drafted the manuscript. D.S., F.F., M.M., X.L., G.Y., L.C., E.G.A, H.S.B., Q.C., A.P., P.B. and S.R.H. reviewed and edited the manuscript. All authors gave final approval of the version to be published.

Corresponding authors

Correspondence to Guoqiang Yu or Elie G. Abu Jawdeh.

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Under a protocol approved by the Institutional Review Board of the University of Kentucky, informed consent was obtained by the research team from each subject’s parent.

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Rabienia Haratbar, S., Chen, L., Cheng, Q. et al. The impact of intermittent hypoxemia on type 1 retinopathy of prematurity in preterm infants. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03169-5

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