THE ORIGINAL description by the Owens of the clinical evolution of the lesions of retrolental fibroplasia stimulated a wide search for a postnatal cause. Conclusive evidence that the administration of oxygen is the major cause has been reviewed. This editorial comment is prompted by the confusion about translating the evidence into Practice.
The data proving the importance of administration of oxygen consist of both clinical and laboratory observations. In 1952 Patz, Hoeck and de la Cruz reported a series of careful, controlled clinical observations from the District of Columbia General Hospital. Alternate infants weighing less than 3.5 pounds at birth were assigned to high or low oxygen and followed with careful ophthalmoscopic examinations for at least 6 months. Oxygen concentrations were measured 3 times daily and flows adjusted to maintain the desired concentrations. In a group of 28 infants kept in 65 to 70% oxygen for 4 to 7 weeks, seven or 25% showed permanent residua which included detachment of the retina. In 37 infants who received minimal oxygen, never more than 40%, from 1 day to 2 weeks, none developed residual changes. During a second year of alternation, these results were confirmed: of a total of 60 infants in high oxygen, 12 showed residua as compared with 1 in low oxygen. These clinical studies have been supported by independent uncontrolled studies from Australia, England, Switzerland, Denver, and Montreal, a more recent controlled study from New York, and an epidemiologic survey in Maryland; they bear out the original suggestion of Kinsey and Zacharias, that increased use of oxygen was one of the changes in care of premature infants which might be responsible for retrolental fibroplasia.
INNOVATIVE DETERMINATION OF NEARSHORE FLOOD FREQUENCY