Influence of oxygen in the development of retinopathy of prematurity

to describe the influence of oxygen in retinopathy of prematurity (ROP) in premature newborns (PTNB) hospitalized in neonatal units of intensive care and undergoing ophthalmological follow-up procedures after hospital discharge.

Method:

retrospective cohort study, from January 2014 to June 2016, whose data collection totaled 181 charts. Descriptive and inferential statistical analysis.

Results:

when using oxygen (O₂) in 148 PTNB (81.7%), both mask (n=141; 77.9%; p-value <0.001) and the tracheal tube predominated (n=100; 55.25; p-value <0.001) for 15 days in average. The time of use and O₂ concentration of the tracheal tube (p-value <0.001), the time of mask use (p-value <0.001) and the time and concentration of O₂ of the continuous positive airway pressure (CPAP) (p-value <0.001) were significant to cause ROP in 50 PTNB (11.31%).

Conclusion:

the oxygen therapy has influenced the development and severity of ROP, indicating the need to adopt protocols for its use.

Descriptors:
Retinopathy of Prematurity; Oxygen; Preventive Health services; Premature Newborn; Nursing

Oxygentherapy	Yes	%	No	%	Min.	Mdn.	Max.	Avg.	Standard Deviation	Variability coefficient (%)
Use of Oxygen	148	81.77	33	18.23
Use of Tube	100	55.25	81	44.75
Tube Time					1.00	7.00	74.00	15.14	16.68	110.15
[%] Tube					14.00	39.71	70.00	39.34	8.44	21.47
Use of mask	141	77.90	40	22.10
Time with the mask					1.00	5.00	52.00	9.10	8.65	95.07
[%] Mask					17.50	35.00	58.00	35.25	5.20	14.75
Use of positive pressure catheter	58	32.04	123	67.96
Catheter time of positive pressure					1.00	4.00	26.00	6.48	6.83	105.39
[%] positive pressure in the catheter					17.00	67.53	55.40	38.08	7.06	18.55
Use of Halo	10	5.52	171	94.48
Halo time					1.00	1.50	3.00	1.60	0.70	43.70
[%] Halo					30.00	40.00	73.30	45.33	12.58	27.76
Use of SB	181	100.0	0	0.00
Time RE					1.00	16.00	53.00	18.65	9.77	52.42
[%] RE					21.00	21.00	21.00	21.00	0.00	0.00

O₂/ROP ratio	Neonatal Intensive Care Unit						Follow-up service
	Without ROP		With ROP		p-v	OR	Without ROP		With ROP		p-v	OR
	A	SD	A	SD	p-v	OR	A	SD	A	SD	p-v	OR
Tube Time	3.93a	8.45	26.43b	19.47	<0.001^* * it gives statistic significance. The variables in bold represent the ones that showed significant mean difference for the absence and presence of ROP. We measured the time of oxygen use in days.	40.64	4.19a	8.69	19.63b	20.20	<0.001^* * it gives statistic significance. The variables in bold represent the ones that showed significant mean difference for the absence and presence of ROP. We measured the time of oxygen use in days.	7.27
[%] Tube	16.62a	19.48	41.96b	9.80		40.64	16.21a	19.19	36.23b	17.03		7.27
Time with the mask	5.34a	7.12	14.40b	9.99	<0.001^* * it gives statistic significance. The variables in bold represent the ones that showed significant mean difference for the absence and presence of ROP. We measured the time of oxygen use in days.	5.77	5.68a	7.93	10.98b	8.95	<0.002^* * it gives statistic significance. The variables in bold represent the ones that showed significant mean difference for the absence and presence of ROP. We measured the time of oxygen use in days.	5.74
[%] Mask	26.14a	16.16	32.98b	9.89		5.77	25.77a	16.73	32.15a	9.36		5.74
Catheter Time	1.30a	3.71	5.31b	7.42	<0.001^* * it gives statistic significance. The variables in bold represent the ones that showed significant mean difference for the absence and presence of ROP. We measured the time of oxygen use in days.	6.00	1.31a	3.79	4.21b	6.73	<0.001^* * it gives statistic significance. The variables in bold represent the ones that showed significant mean difference for the absence and presence of ROP. We measured the time of oxygen use in days.	3.27
[%] Catheter	9.18a	16.71	24.82b	19.27		6.00	9.35a	16.69	20.10b	20.19		3.27
Halo time	0.08a	0.37	0.08a	0.51	0.69	0.45	0.09a	0.39	0.06a	0.43	0.29	0.29
[%] Halo	2.60a	10.38	2.09a	12.39	0.69	0.45	2.86a	10.84	1.53a	10.58	0.29	0.29
Time of SB	18.69a	9.68	18.46a	10.32	--	--	18.35a	10.01	19,48a	9.14	--	--
[%] SB	21.00a	0.00	21.00a	0.00	--	--	21.00a	0.00	21.00a	0.00	--	--

Standardized coefficients of the discriminant function	Neonatal intensive care unit	Follow-up
Tube Time	-0.886	-0.821
Oxygen Concentration Tube	-0.188	-0.333
Time with the mask	-0.213	0.249
Oxygen Concentration Mask	0.154	0.012
Catheter Time	-0.288	-0.374
Concentration Oxygen Catheter	-0.168	-0.111
Overall accuracy (x100)^(a) (a) % of correct classifications; Tube: Tracheal tube; Catheter: continuous positive airway pressure.	87.85	77.90
Proportional Chance Criterion (x100)	68.80	61.03
% error in the group "without ROP"	4.97	5.52
% error in the group "with"	7.18	16.58

Characteristics	NO		YES
Characteristics	N	%	N	%
Blood transfusion	13	260	37	74
Use of oxygen	0	0	50	100
ROP only in the right eye	7	14	43	86
ROP only in the left eye	1	2	49	98
ROP in both eyes	8	16	42	84

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding Author: Beatriz Rosana Gonçalves de Oliveira Toso. E-mail: beatriz.oliveira@unioeste.br

Left eye ROP	Evaluation of children in Neonatal Intensive Care Unit (N = 181)
	Right eye ROP										Total
	Without ROP		G1		G2		G3		G4
	N	%	N	%	N	%	N	%	N	%	N	%
Without ROP	146	80.67	1	0.55	0	0.0	0	0.0	0	0	147	81.22
G1	0	0	13	7.19	2	1.1	0	0	0	0	15	8.29
G2	0	0	1	0.55	7	3.87	1	0.55	0	0	9	4.97
G3	0	0	0	0	2	1.1	7	3.87	0	0	9	4.97
G4	0	0	0	0	0	0	0	0	1	0.55	1	0.55
Total	146	80.67	15	8.29	11	6.07	8	4.42	1	0.55	181	100
Left eye ROP	Follow-up evaluation (N=50)
	Right eye ROP										Total
	Without ROP		G1		G2		G3
	N	%	N	%	N	%	N		%		N	%
Without ROP	1	2	1	2	0	0	0		0.0		2	4
G1	7	14	25	50	1	2	1		2		34	68
G2	0	0	4	2	3	6	2		4		9	18
G3	0	0	0	0	0	0	7		14		7	14
Total	8	16	28	56	4	8	10		20		50	100
RE Zone			3	6	16	32	31		62		50	100
LE Zone			1	2	15	30	34		68		50	100
LE/RE	Evaluation of severe ROP cases (N=10)
	G1		G2		G3		Total
	N	%	N	%	N	%	N		%
G1	1	10	0	0	1	10	2		20
G2	0	0	2	20	0	0	2		20
G3	0	0	0	0	6	60	6		60
Total	1	20	2	20	6	70	10		100
RE Zone	2	20	5	50	3	30	10		100
LE Zone	1	10	5	50	4	40	10		100