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Effects of fetal haemoglobin on systemic oxygenation in preterm infants and the development of retinopathy of prematurity PacIFiHER Report No. 2
  1. Kim Jiramongkolchai1,
  2. Michael X Repka2,
  3. Jing Tian3,
  4. Sue W Aucott4,
  5. Jennifer Shepard4,
  6. Megan Collins2,
  7. Julia Clemens5,
  8. Mia Feller6,
  9. Irina Burd7,
  10. Marina Roizenblatt8,9,
  11. Kerry Smith10,
  12. J Fernando Arevalo9,
  13. Peter L Gehlbach9,
  14. James T Handa9
  15. PacIFiHER study group (preterm infants and foetal haemoglobin in retinopathy of prematurity)
  1. 1Retina, Kaiser Permanente Medical Center, Mclean, Virginia, USA
  2. 2Pediatric Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
  3. 3Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  4. 4Pediatrics, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
  5. 5University of Vermont College of Medicine, Burlington, Vermont, USA
  6. 6School of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
  7. 7Obstretrics and Gynaecology, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
  8. 8Universidade Federal de Sao Paulo Escola Paulista de Medicina, Sao Paulo, Brazil
  9. 9Retina, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
  10. 10Information Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Kim Jiramongkolchai, Kaiser Permanente Medical Center, Mclean, Virginia 22102, USA; jiramong{at}gmail.com

Abstract

Background/aims Fetal haemoglobin (HbF) has an oxyhaemoglobin dissociation curve that may affect systemic oxygenation and the development of retinopathy of prematurity (ROP). The study aim is to characterise the effects of HbF levels on systemic oxygenation and ROP development.

Methods Prospective study conducted from 1 September 2017 through 31 December 2018 at the Johns Hopkins NICU. Preterm infants with HbF measured at birth, 31, 34 and 37 weeks post-menstrual age (PMA), complete blood gas and SpO2 recorded up to 42 weeks PMA, and at least one ROP exam were included.

Results Sixty-four preterm infants were enrolled. Higher HbF was associated with significantly higher SpO2, lower PCO2, lower FiO2 from birth to 31 weeks PMA and 31 to 34 weeks PMA (rs=0.51, rs=−0.62 and rs=−0.63; p<0.0001 and rs=0.71, rs=−0.58 and rs=−0.79; p<0.0001, respectively). To maintain oxygen saturation goals set by the neonatal intensive care unit, higher median FiO2 was required for HbF in the lowest tercile from birth compared with HbF in the highest tercile to 31 weeks and 31 to 34 weeks PMA; FiO2=35 (21–100) versus 21 (21–30) p<0.006 and FiO2=30 (28–100) versus 21 (21–30) p<0.001, respectively. Preterm infants with ROP had poorer indices of systemic oxygenation, as measured by median levels of SpO2 and PCO2, and lower levels of HbF (p<0.039 and p<0.0001, respectively) up to 34 weeks PMA.

Conclusion Low HbF levels correlated with poor oxygenation indices and increased risk for ROP. O2 saturation goals to prevent ROP may need to incorporate relative amount of HbF.

  • retina
  • neovascularisation
  • physiology
  • treatment other

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. All data relevant to this study are included in the article.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. All data relevant to this study are included in the article.

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Footnotes

  • Contributors Substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work: KJ, MXR, JT, SWA, JS, MC, JC, MF, IB, MR, KS, JFA, PLG, JTH. Drafting the work or revising it critically for important intellectual content: KJ, MXR, JT, SWA, JS, MC, JC, MF, IB, MR, KS, JFA, PLG, JTH. Final approval of the version to be published: KJ, MXR, JT, SWA, JS, MC, JC, MF, IB, MR, KS, JFA, PLG, JTH. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: KJ, MXR, JT, SWA, JS, MC, JC, MF, IB, MR, KS, JFA, PLG, JTH.

  • Funding Knights Templar grant (KJ), Mr and Mrs Carol Sprague (KJ), ARVO Alcon Early Investigator Career Award (KJ), unrestricted grant to Wilmer Eye Institute from Research to Prevent Blindness (JTH), Robert Bond Welch Professorship (JTH); Research to Prevent Blindness, New York, New York, USA, and gifts by the J. Willard and Alice S. Marriott Foundation, the Gale Trust, Mr Herb Ehlers, Mr Bill Wilbur, Mr and Mrs Rajandre Shaw, Ms Helen Nassif, Ms Mary Ellen Keck, Don and Maggie Feiner, and Mr Ronald Stiff, J.W. Marriott Jr. Professorship (PLG).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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