ASSOCIATION BETWEEN OXYGEN THERAPY PRACTICES AND SEVERITY OF RETINOPATHY OF PREMATURITY IN PRETERM NEONATES

Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness, particularly in preterm neonates requiring intensive care. Although supplemental oxygen is essential for survival in this population, it is also a key modifiable determinant of the development and progression of ROP.  To evaluate the association between oxygen therapy practices duration, mode of delivery and oxygen-saturation patterns and the severity of ROP in preterm neonates. A prospective observational study was conducted over 18 months in the neonatal intensive care unit (NICU) of a tertiary care hospital. Preterm neonates of gestational age ≤ 34 weeks or birth weight ≤ 2,000 g requiring supplemental oxygen and undergoing ROP screening were enrolled. Data on oxygen exposure (duration, mode of delivery and SpO₂ patterns) were recorded prospectively, and ROP was screened and classified by an experienced ophthalmologist using indirect ophthalmoscopy in accordance with the International Classification of Retinopathy of Prematurity. Severe ROP was defined as treatment-requiring or advanced-stage disease.  Of 100 enrolled neonates, 60 (60.0%) developed ROP, of whom 23 (38.3%) had severe disease. Lower mean gestational age (30.2 ± 2.1 vs. 32.5 ± 1.8 weeks; p < 0.01) and birth weight (1,250 ± 220 vs. 1,500 ± 250 g; p < 0.01) were significantly associated with the occurrence of ROP. Severe ROP was significantly associated with longer duration of oxygen therapy (> 5 days; p < 0.001), mechanical ventilation (p < 0.05) and fluctuating or persistently high (> 95%) SpO₂ patterns (p < 0.01). Prolonged oxygen exposure, invasive respiratory support and unstable SpO₂ patterns are associated with more severe ROP in preterm neonates. Careful titration of inspired oxygen, adherence to recommended saturation targets and implementation of standardised NICU oxygen protocols are likely to reduce the burden of severe ROP, particularly in resource-limited settings.