NeoNotes Journal Club
Andrew B. Kairalla MD, Editor
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The HOPE-ROP Study
Retinopathy of Prematurity Outcome in Infants With Prethreshold Retinopathy of Prematurity and Oxygen Saturation >94% in Room Air: The High Oxygen Percentage in Retinopathy of Prematurity Study. McGregor ML, Bremer DL, Cole C, et al. PEDIATRICS (September 2002); 110: 540-544
.Objectives. To determine the rate of progression from prethreshold to threshold retinopathy of prematurity (ROP) in infants excluded from Supplemental Therapeutic Oxygen for Prethreshold Retinopathy of Prematurity (STOP-ROP) because their median arterial oxygen saturation by pulse oximetry (SpO2) values were >94% in room air at the time of prethreshold diagnosis and to compare them with infants who were enrolled in STOP-ROP and had median SpO2 <94% in room air.
Methods. Fifteen of the 30 centers that participated in STOP-ROP elected to participate in the High Oxygen Percentage in Retinopathy of Prematurity study (HOPE-ROP) from January 1996 to March 1999. Infants were followed prospectively from the time prethreshold ROP was diagnosed until ROP either progressed to threshold in at least 1 study eye (adverse outcome) or resolved (favorable outcome).
Results. A total of 136 HOPE-ROP infants were compared with 229 STOP-ROP infants enrolled during the same time period from the same 15 hospitals. HOPE-ROP infants were of greater gestational age at birth (26.2 ± 1.8 vs 25.2 ± 1.4 weeks) and greater postmenstrual age at the time of prethreshold ROP diagnosis (36.7 ± 2.5 vs 35.4 ± 2.5 weeks). HOPE-ROP infants progressed to threshold ROP 25% of the time compared with 46% of STOP-ROP infants. After gestational age, race, postmenstrual age at prethreshold diagnosis, zone 1 disease, and plus disease at prethreshold diagnosis were controlled for, logistic regression analysis showed that HOPE-ROP infants progressed from prethreshold to threshold ROP less often than STOP-ROP infants (odds ratio: 0.607; 95% confidence interval: 0.359–1.026).
Comment: We learned in the STOP-ROP trial that giving supplemental oxygen (to keep SpO2 > 94%) to premature infants with pre-threshold ROP did little to reduce the rate of progression to threshold disease. Now we see in the HOPE-ROP trial that the group of infants who were excluded from the STOP-ROP trial because their SpO2 was already > 94% in room air have a significantly lower rate of progression to threshold ROP. Perhaps the degree of oxygen exposure in the first weeks of life is a more critical variable in preventing severe ROP. This was suggested in a commentary written by Dr Win Tin that was published in the same issue of Pediatrics. A recent presentation by Dr Tin on the ideal SpO2 range for VLBW infants was given at the 2001 Hot Topics Meeting, and reviewed in NeoNotes (
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