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Optimizing Retinopathy of Prematurity Management in the NICU
Dissertation

Optimizing Retinopathy of Prematurity Management in the NICU

Shelby Neal
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2026
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Abstract

Background: Retinopathy of Prematurity (ROP) affects many premature infants globally and in the United States each year, with some experiencing severe vision impairment or blindness if not properly managed. In utero, the retina grows in a low-oxygen environment, but supplemental oxygen in the Neonatal Intensive Care Unit (NICU) can slow normal retinal vessel development and trigger abnormal growth. Careful monitoring and intervention are essential to prevent long-term vision loss. Purpose: This project aimed to improve ROP prevention in premature infants through a standardized oxygen titration algorithm and a visual aid owl tool using evidence-based practice principles. Methods: The Iowa Model for Evidence Based Practice was the framework used to structure this project. Interventions included nurse education, implementation of a standardized oxygen titration algorithm, implementation of the ROP visual owl aid tool, pre- and post-surveys assessing baseline ROP knowledge, and bi-monthly bedside audits evaluating the visual aid owl tool. These interventions assessed nurses’ knowledge, confidence, adherence to oxygen protocols, and the utility of the visual aid, with a goal of reducing ROP incidence by 30% once the algorithm was implemented. Findings: Completion of ROP education increased, with 84.47% of nurses participating. Increased nurse confidence in ROP knowledge was observed, with extreme confidence rising from 8.00% to 23.00%. Increased perceived usefulness of the visual aid owl tool was reported, with 77.70% of nurses rating it as helpful. The oxygen titration algorithm was successfully implemented. Trends suggested that the algorithm, in combination with other evidence-based interventions, may have contributed to improved patient outcomes. Discussion: Implementation of the oxygen titration algorithm and the visual aid owl tool strengthened nursing knowledge, standardized bedside decision-making, improved oxygen management consistency, increased confidence, and established a sustainable framework for ongoing ROP prevention in premature infants.
 retinopathy of prematurity premature infants oxygen neonatal intensive care unit nurses

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