450 - Is Elective Intubation for Laser Treatment of Retinopathy of Prematurity Beneficial?

Publication Number: 450.5932

Jason Peng, Cooper Medical School of Rowan University, Rockville, MD, United States; Raghav Taneja, University of Texas Southwestern Medical School, Dallas, TX, United States; Barry N. Wasserman, Wills Eye Hospital, Robbinsville, NJ, United States; Alla Kushnir, The Children's Regional Hospital at Cooper, Camden, NJ, United States

Background: Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness in preterm infants with low birth weight. Laser retinopexy is a primary treatment, but it demands careful respiratory management. Optimal respiratory support during ROP laser treatment remains undefined, with varying practices between centers.

Objective: To compare short term respiratory outcomes of infants electively intubated prior to ROP laser treatment and those not intubated.

Design/Methods: This IRB approved, retrospective case-control study analyzed data of preterm infants who underwent laser retinopexy at two centers by a single surgeon between 2010 and 2020 and compared those who were electively intubated (ETT group) vs those who were not (No-ETT group). Data was collected using EPIC EHR and included neonatal demographics, ROP stage at time of treatment, respiratory data, ROP stage at the time of treatment, incidence of necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and intraventricular hemorrhage (IVH). Infants who were intubated prior to needing the procedure were excluded from analysis.

Results: Of the 93 infants evaluated, 32 were electively intubated, while 61 underwent the procedure without intubation. There was no difference in the total duration of respiratory support post-surgery (32.1 days in No-ETT vs. 25.6 days in ETT, p=0.43). There was no difference in the duration of respiratory support post laser (27.43 vs 24.34 days, p=0.68). At No-ETT center, 6 babies were emergently intubated for the procedure and 1 was electively intubated, while at ETT center 29 babies were electively intubated for the procedure. The duration of ventilator requirement in those intubated for laser was significantly shorter for babies in ETT center (n=7 vs 29; mean 4.43 vs 1.62 days, p=0.006).

Conclusion(s): By not having elective intubation, there are fewer babies who were subjected to this invasive procedure, with only 14% of all neonates requiring intubation at No-ETT center, compared to 100% in the ETT center. However, the approach of universal intubation for ROP treatment only increased the duration of mechanical ventilation by 1.6 days and did not influence the total duration of respiratory support between the two groups.