HFNC OXYGEN PLUS
There is little doubt that ROP is a complicated disease with a variety of stages, zones, as well as plus disease. Compared to laser ablation, which destroys the peripheral retina, noninvasive oxygen supplementation has potential advantages for visual function improvement. Our findings strongly suggest that supplemental oxygen can be an effective alternative method for early-stage ROP. 25 In our study, 16 of 20 infants achieved ROP regression without laser ablation.
Nevertheless, our preliminary findings strongly demonstrated that HFNC therapy was effective for Hrp-ROP regression.Īlthough the laser ablation has a definite effect, its long-term visual functional side effects, such as myopia and visual field impairment, remain major concerns. 23 These factors might induce less severe ROP as well as better tolerance for supplemental therapy, and, therefore, a biased result. 25.4 ± 1.5 weeks, respectively), and the intervention time was later (37.4 ± 3.8 vs. Compared to the STOP-ROP study, infants in our study had larger BW and older GA (1302 ± 299 vs. Conversely, the STOP-ROP study showed that supplemental oxygen therapy has no significant benefits for ROP regression. Both aforementioned results are consistent with our findings. 22 reported significantly decreased ROP progression after implementation of an oxygen therapy protocol (23% vs. 24 reported the significantly decreased ROP progression from 37% to 7% when the SO2 was targeted from <95% to 99%. 8, 22, 24 In our study, 20 prethreshold ROP infants who met the criteria for invasive treatment were treated with HFNC, and the ROP regression rate was 80% (16/20), which was higher than that in conventional observation (80% vs. At any point during the observation period, if the ROP was getting worse, the HFNC was terminated and laser photocoagulation or intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs (0.25 mg, 10 mg/mL Ranibizumab Lucentis, Novartis, Basel, Switzerland) was performed to treat the progressed ROP.įor decades, several studies focused on the benefits of supplemental oxygen therapy as a noninvasive method of ROP treatment while the results remain controversial. The observation was closely performed every day after HFNC for the first 3 days, followed by every 3 days in the next 2 weeks, and then followed by once a week if ROP had not yet regressed. Fundus observation was performed by the same experienced ophthalmologist with a binocular indirect ophthalmoscope and a RetCam 3 digital imaging system (Clarity Medical Systems, Inc., Pleasanton, CA) was used if the fundus had obvious changes. FiO 2 was set to 25% and the gas flow was initially at 6 L/min from Precision Flow device (Vapotherm, Exeter, NH) and adjusted between 4 and 10 L/min to maintain blood SO 2 at 95% to 98% according to the continuous pulse oximeter (IntelliVue MP5 Philips, Hamburg, Germany). Preterm infants enrolled in this study were treated with continuous heated and humidified HFNC. Our study suggests that HNFC can be an alternative treatment for Hrp-ROP, potentially avoiding the problems caused by other invasive treatment. The progression of Hrp-ROP was significantly decreased after HFNC oxygen supplementation with slightly tolerable complication. The main complication of HNFC was nasal erosion associated with airflow and HFNC duration (RR = 1.8, P = 0.026 RR = 1.8, P = 0.026, respectively). 96.6 ± 0.8%, P < 0.001), while the heartbeat rate (HR) and respiratory rate (RR) had no significant differences (139.4 ± 5.4 vs. The blood saturation of oxygen was significantly increased after HFNC (92 ± 1.3% vs. No significant differences between regression and progression cases were found for gestational age, birth weight, plus disease, age for HFNC, and SO2 level. The anti-VEGF treated patient encountered ROP recurrence one month after injection and was treated successfully by additional HFNC. Among four progressed ROP infants, three were treated with laser photocoagulation and one received anti-vascular endothelial growth factor (VEGF) therapy. With HFNC, 16 of 20 infants with Hrp-ROP experienced regression, which is higher than the natural regression rate, comparing to the data in other clinical trials (52% in the STOP-ROP study). Statistical analysis with independent samples t-tests and Fisher's exact tests was performed, and forest plots were created to illuminate the odds ratio of factors associated with ROP regression as well as HFNC complication. We evaluated the effect of heated and humidified high flow nasal cannula (HFNC) oxygen supplementation to promote regression of high-risk prethreshold retinopathy of prematurity (Hrp-ROP) in premature infants.Ī prospective study was designed for Hrp-ROP premature infants undergoing HFNC oxygen supplementation to evaluate its capacity for promoting ROP regression.
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