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Oxygen and retrolental fibroplasia
743
CORRESPONDENCE
OXYGEN AND RETROLENTAL FIBROPLASIA WANT to congratulate Dr. Lanman for his excellent discussion on the control of oxygen t h e r a p y for the prevention of retrolcntal tlbroplasla. As Dr. Lanman states, the New York City I t e a l t h Departm e a t ' s Premature Transport Service limits oxygen concentration even though the trips seldom exceed forty-five minutes. In addition to thls~ the New York City Departmcnt of Health also issued in April, 1954, the recommendations which were approved by t h e Pediatric Advisory Committee on March 17, 1954, relating to retrolental fibroplasia as follows: " R e c e n t studies suggest a possible interrelationship b e t w e e n high concentrations of oxygen and the development of retrolental flbroplasia in premature infants. I t has therefore been recommended by the Pedlatrie Advisory Committee t h a t premature i n f a n t s receive oxygen only as needed, and then in concentrations not to exceed 40 volumes per cent. " T h e Committee emphasizes t h a t inasmuch as the concentration of oxygen cannot be reliably measured in terms of liter flow, determinations of oxygen concentrations should be made by means of oxygen analyzers at periodic i n t e r v a l s . " I t was disseminated to all m a t e r n i t y and newborn services and to the entire profession. Premature centers have also been requested to report to the Department of Health any cases of retrolental flbroplasia which may occur on their services. Through the periodic hospital inspections and surveys made by the staff of the N a t e r n l t y and Newborn Division, a c a r e f u l checkup is also made of the hospital policy with regard to the administration of oxygen to premature i n f a n t s and the necessary r~com-
inundations are made as indicated. A joint advisory committee of pediatricians, obstetricians, and ophthalmologists was appointed. The subject was reviewed and I stated then t h a t "despite previous recommendations of the Department of Health and the Pediatric Advisory Committee that oxygen concentrations of 40 per cent or less be used in the nursery care of infants~ at present many hospitals are still using higher concentratlons." It was recommended that: 1. Oxygen concentration be used for premature infants in delivery rooms on obstetrical services below 40 volumes per cent and not eontinually but only when indicated.
2. Concentrations be checked with oxygen analyzer. 3. An ophthalmologist make periodic ophthalmological examinations in all premature nurseries and on all premature infants. It m a y be stated that there has definitely been a reduction in the incidence of retrolental fibroplasia among premature i n f a n t s born in 1954 as compared with those born in 1953. While complete figures are as yet unavailable, we only know at present of four i n f a n t s who were reported to the State Commission for the Blind who have ~been born during 1964. This does not mean, however, t h a t only four cases of retrolental fibroplasia occurred in i n f a n t s born in 1954 for there is a considerable lapse between date of b i r t h and reporting the blindness, but it definitely shows a considerable drop since there were over sixty cases reported during the year 1953. ~-IAROLD JACOBZINEg, 1VLI).
CORRESPONDENCE
OXYGEN AND RETROLENTAL FIBROPLASIA WANT to congratulate Dr. Lanman for his excellent discussion on the control of oxygen t h e r a p y for the prevention of retrolcntal tlbroplasla. As Dr. Lanman states, the New York City I t e a l t h Departm e a t ' s Premature Transport Service limits oxygen concentration even though the trips seldom exceed forty-five minutes. In addition to thls~ the New York City Departmcnt of Health also issued in April, 1954, the recommendations which were approved by t h e Pediatric Advisory Committee on March 17, 1954, relating to retrolental fibroplasia as follows: " R e c e n t studies suggest a possible interrelationship b e t w e e n high concentrations of oxygen and the development of retrolental flbroplasia in premature infants. I t has therefore been recommended by the Pedlatrie Advisory Committee t h a t premature i n f a n t s receive oxygen only as needed, and then in concentrations not to exceed 40 volumes per cent. " T h e Committee emphasizes t h a t inasmuch as the concentration of oxygen cannot be reliably measured in terms of liter flow, determinations of oxygen concentrations should be made by means of oxygen analyzers at periodic i n t e r v a l s . " I t was disseminated to all m a t e r n i t y and newborn services and to the entire profession. Premature centers have also been requested to report to the Department of Health any cases of retrolental flbroplasia which may occur on their services. Through the periodic hospital inspections and surveys made by the staff of the N a t e r n l t y and Newborn Division, a c a r e f u l checkup is also made of the hospital policy with regard to the administration of oxygen to premature i n f a n t s and the necessary r~com-
inundations are made as indicated. A joint advisory committee of pediatricians, obstetricians, and ophthalmologists was appointed. The subject was reviewed and I stated then t h a t "despite previous recommendations of the Department of Health and the Pediatric Advisory Committee that oxygen concentrations of 40 per cent or less be used in the nursery care of infants~ at present many hospitals are still using higher concentratlons." It was recommended that: 1. Oxygen concentration be used for premature infants in delivery rooms on obstetrical services below 40 volumes per cent and not eontinually but only when indicated.
2. Concentrations be checked with oxygen analyzer. 3. An ophthalmologist make periodic ophthalmological examinations in all premature nurseries and on all premature infants. It m a y be stated that there has definitely been a reduction in the incidence of retrolental fibroplasia among premature i n f a n t s born in 1954 as compared with those born in 1953. While complete figures are as yet unavailable, we only know at present of four i n f a n t s who were reported to the State Commission for the Blind who have ~been born during 1964. This does not mean, however, t h a t only four cases of retrolental fibroplasia occurred in i n f a n t s born in 1954 for there is a considerable lapse between date of b i r t h and reporting the blindness, but it definitely shows a considerable drop since there were over sixty cases reported during the year 1953. ~-IAROLD JACOBZINEg, 1VLI).