452 - Sex-Based Differences in ROP Progression and Outcomes with Higher Oxygen Saturation

Publication Number: 452.6888

Katherine Vogel, Indiana University School of Medicine, Indianapolis, IN, United States; Noor Abdullah, Indiana University School of Medicine, Indianapolis, IN, United States; Rina Jiang, Indiana University School of Medicine, Indianapolis, IN, United States; Kelsey Robinson, Indiana University School of Medicine, Ann Arbor, MI, United States; Charline Boente, Indiana University, Indianapolis, IN, United States; Kathryn Haider, Indiana University School of Medicine, Indianapolis, IN, United States; Kok Lim Kua, Indiana University School of Medicine, Indianapolis, IN, United States

Background: Preterm infants experience high risk of developing retinopathy of prematurity (ROP), a leading cause of childhood blindness. The pathophysiology of ROP involves an initial vaso-obliterative phase followed by a vaso-proliferative phase after 32-weeks corrected gestational age. Additionally, sex differences play a role in ROP disease progression, with male infants having more severe ROP needing laser photocoagulation or intravitreal bevacizumab (IVB). Previous studies also proposed that the use of supplemental oxygen may decrease ROP progression during the vaso-proliferative phase.

Objective: The purpose of this study is to assess sex differences in preterm infant risks of ROP progression and determine whether higher oxygen saturation target during vaso-proliferative phase reduces the need for laser or IVB.

Design/Methods: This is a retrospective chart review of preterm infants admitted to Riley Hospital for Children Neonatal Intensive Care Unit diagnosed with stage 2 ROP from 1/2017 and 3/2024. A higher oxygen saturation target was implemented in July 2019 to maintain O2 saturation between 97-99% in preterm infants with stage 2 ROP. Outcomes were compared between two cohorts: pre-protocol implementation (124 participants) and post-O2 protocol implementation (162 participants). Key outcomes include the need for laser/IVB therapy, length of stay (LOS), and time on respiratory support therapy were assessed using Chi-square tests followed by logistic regression.

Results: The primary outcome revealed that male infants with stage 2 ROP are more likely to receive laser/IVB than female infants, regardless of oxygen use (OR = 1.89, CI 1.06-3.42; p = 0.0033). Higher O2 saturation target during vaso-proliferative phase decreases the likelihood of laser/IVB (OR 0.28, CI 0.14-0.51; p=0.000), but this decrease in risks was not statistically different between sexes (p = 0.316). Considering sex and O2 interaction, female babies have a higher number of days than males when not on O2, but males have a higher number of days than females when on O2. However, the interactions for time on nasal cannula and any respiratory support remained insignificant.

Conclusion(s): Based on this cohort’s findings, current protocol to increase oxygen therapy for ROP treatment equally improves the short-term outcomes of likelihood of laser/IVB in both sexes. However, additional research is required to determine sex-differences in response to O2 therapy on LOS/CPAP need, as well as the long-term outcomes of retinal disease is crucial.