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Research Article: Association of early oxygen therapy parameters with retinopathy of prematurity stages in preterm infants with respiratory distress syndrome: a gestational age-stratified analysis

Date Published: 2026-08-12

Abstract:
To investigate the associations between early oxygen-related parameters and ROP severity in preterm infants with respiratory distress syndrome (RDS), and to evaluate their discriminative performance for severe ROP. This retrospective study included 825 preterm infants (24–<37 weeks) with RDS stratified by gestational age (32–<37, 28–<32, and 24–<28 weeks). Early oxygen parameters during the first 7 days after birth included cumulative oxygen duration, mean and maximum FiO 2 , SpO 2 target range time proportion (91%–95%), and intermittent hypoxia frequency. Correlation analysis, multivariable logistic regression, and ROC analyses were performed. ROP incidence was 12.97% (107/825) and increased with decreasing gestational age (1.21%, 25.80%, and 59.57%, respectively; P <?0.001). Compared with mild ROP, severe ROP showed longer oxygen duration, higher FiO 2 exposure, more intermittent hypoxia episodes, and lower SpO 2 target range time proportion (all P <?0.05). After adjustment for gestational age, birth weight, and surfactant use, none of the oxygen-related parameters remained independently associated with severe ROP. ROC analysis among infants with ROP showed moderate discrimination for individual oxygen parameters (AUC: 0.705–0.761), whereas models incorporating oxygen parameters showed limited improvement beyond gestational age and birth weight. Early oxygen-related parameters were associated with ROP severity but showed limited independent discriminative value beyond gestational age and birth weight. They may represent candidate markers for risk characterization, although prospective validation is required before clinical application.

Introduction:
Retinopathy of prematurity (ROP) is a common and severe retinal vasoproliferative disorder in preterm infants and a major cause of avoidable childhood blindness ( 1 – 3 ). Advances in perinatal medicine and neonatal intensive care have significantly improved survival rates for very low birth weight and extremely preterm infants, with a continued increase in the number of ROP cases ( 4 ). In developing countries especially, variations in oxygen therapy management and neonatal care capacity across regions have led…

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