Abstract
Background: Variation in the uptake of evidence-based practices and adoption of unproven therapies by neonatal intensive care units might contribute to clinical variability. Objective was to survey current oxygen saturation targets (SpO2), the use of automatic adjustment of inspired oxygen in infants on respiratory support, the criteria for routine retinal examinations for ROP and the use of anti-vascular endothelial growth factor (VEGF) agents to treat ROP in the International Network for Evaluating Outcomes for Neonates (iNeo).
Methods: Online pre-piloted anonymous questionnaires on care practices in 2023 for extremely preterm (<29 weeks) infants were sent to the Directors of 608 NICUs in the iNeo. Four questions concerned ROP management and results were compared with a similar 2015 survey.
Results: There were 11 participating networks from 12 high-income countries and one from a middle-income country. The overall NICU response rate was 63% (382 units). Despite variability between NICUs, within networks there was limited change in SpO2 targets between 2015 and 2023. The median upper and lower SpO2 targets were 95% and 89%; in 18% of NICUs the upper target was ≥96%, in 13% the lower target was ≤85%. Automated loop systems for controlled oxygen delivery were used in 24% of NICUs. Most NICUs (78%) used a combination of birthweight and gestation as ROP screening criteria. Intravitreal anti-VEGF agents were used to treat ROP in all networks and by 76% of NICUs.
Conclusions: There was considerable variation in care practices between NICUs and the relationship of this to clinical outcomes should be explored.