# Comparison of Ventilation Support During Laser Treatment of Retinopathy of Prematurity

## TL;DR

Elective intubation during ROP laser surgery in preterm infants leads to longer mechanical ventilation without improving recovery time or outcomes.

## Contribution

This study is the first to show that routine elective intubation during ROP laser surgery does not improve clinical outcomes and may be unnecessary.

## Key findings

- Infants with elective intubation had longer post-surgery mechanical ventilation than those without.
- No significant differences were found in hospital stay or comorbidities between the groups.
- Over 90% of infants without intubation tolerated the procedure safely.

## Abstract

What are the main findings?
Preterm infants undergoing ROP laser surgery with routine elective intubation had significantly longer durations of post-operative mechanical ventilation.Routine intubation during this procedure did not improve short-term clinical outcomes, such as overall hospital length of stay or timing of laser intervention in the infant’s life.

Preterm infants undergoing ROP laser surgery with routine elective intubation had significantly longer durations of post-operative mechanical ventilation.

Routine intubation during this procedure did not improve short-term clinical outcomes, such as overall hospital length of stay or timing of laser intervention in the infant’s life.

What are the implications of the main findings?
Routine intubation strategies may unnecessarily increase exposure to mechanical ventilation without improving clinical outcomes.Standardization of perioperative intubation practices across hospitals may be needed to optimize respiratory support in this vulnerable population.

Routine intubation strategies may unnecessarily increase exposure to mechanical ventilation without improving clinical outcomes.

Standardization of perioperative intubation practices across hospitals may be needed to optimize respiratory support in this vulnerable population.

Objective: To compare respiratory outcomes between infants undergoing retinopathy of prematurity (ROP) laser treatment with or without elective intubation. Study Design: This retrospective cohort study analyzed preterm infants treated by the same pediatric ophthalmologist at two tertiary hospitals between January 2010 and March 2023, Hospital 1 (No-endotracheal tube or ETT intubation) and Hospital 2 (ETT intubation). Infants intubated for unrelated reasons or treated with only anti-vascular endothelial growth factor (VEGF) injections were excluded. Data collected included demographics, comorbidities, ROP stage, and respiratory outcomes. Results: Among 91 infants (61 No-ETT, 30 ETT), the No-ETT group had significantly lower birth weight and had more Black infants. The mean duration of mechanical ventilation post-surgery was significantly shorter in the No-ETT than in the ETT cohort (0 vs. 1 days, p = 0.005), and the total respiratory support (both invasive and non-invasive) after surgery was significantly longer in the No-ETT than in the ETT cohort (108 vs. 4.5 days, p < 0.001). No statistically significant differences were observed between groups in terms of length of hospital stay after surgery. The two cohorts demonstrated similar clinical trajectories with respect to overall length of hospital stay, day of life at which laser surgery was performed, and multiple comorbidities. Over 90% of No-ETT infants tolerated the procedure without requiring elective intubation, with emergent intubation only occurring 9.8% of the time. Conclusions: Elective intubation during ROP surgery was associated with a longer length of post-surgery mechanical ventilation without clear improvements in short-term outcomes. Similar rates of multiple comorbidities, hospital length of stay, and timing of laser surgery suggest there is no associated clinical advantage to routine elective intubation. Routine elective intubation may be unnecessary for most infants during ROP laser surgery.