Automated Adjustment of Inspired Oxygen in Preterm Infants with Frequent Fluctuations in Oxygenation: A Pilot Clinical Trial

Objective

To assess the efficacy of a system for automated fraction of inspired oxygen (FiO₂) adjustment in maintaining oxygen saturation (SpO₂) within an intended range in preterm infants with spontaneous fluctuations in SpO₂.

Study design

Sixteen infants (gestational age, 24.9 ± 1.4 weeks; birth weight, 678 ± 144 g; age, 33 ± 15 days) with frequent hypoxemia episodes underwent two 4-hour periods of FiO₂ adjustment by clinical personnel (routine) and the automated system (automated).

Results

Compared with the routine period, the percent time within intended SpO₂ range (88%-95%) increased during the automated period (58% ± 10% versus 42% ± 9%; P < .001), whereas the percent time with SpO₂ higher than the intended range and ≥98% were reduced (9% ± 10% versus 31% ± 8% [P < .001] and 3% ± 5% versus 16% ± 9% [P < .001], respectively). Percent time with SpO₂ < 88% increased during the automated period (33% ± 7% versus 27% ± 9%; P = .003) because of more frequent episodes, whereas the time with SpO₂ < 75% did not differ. The 4-hour median FiO₂ was lower during the automated period (29% ± 4% versus 34% ± 5%; P < .001).

Conclusion

Automated FiO₂ adjustment improved maintenance of SpO₂ within the intended range and reduced hyperoxemia and FiO₂. These findings should be examined in longer periods with standard clinical conditions and, eventually, in the context of randomized trials powered to detect clinically important effects on outcome.

FiO₂, Fraction of inspired oxygen, SpO₂, Oxygen saturation