OBJECTIVE: Neonatal exposure to episodic hypoxemia and hyperoxemia is highly relevant to outcomes. Our goal was to investigate the differences in the frequency and duration of extreme low and high SpO2 episodes between automated and manual inspired oxygen control. DESIGN: Post-hoc analysis of a cohort from prospective randomized cross-over studies. SETTING: Seven tertiary care neonatal intensive care units. PATIENTS: Fifty-eight very preterm neonates (32 or less weeks PMA) receiving respiratory support and supplemental oxygen participating in an automated versus manual oxygen control cross-over trial. MAIN MEASURES: Extreme hypoxemia was defined as a SpO2 < 80%, extreme hyperoxemia as a SpO2 > 98%. Episode duration was categorized as < 5 seconds, between 5 to < 30 seconds, 30 to < 60 seconds, 60 to < 120 seconds, and 120 seconds or longer. RESULTS: The infants were of a median postmenstrual age of 29 (28-31) weeks, receiving a median FiO2 of 0.28 (0.25-0.32) with mostly receiving non-invasive respiratory support (83%). While most of the episodes were less than 30 seconds, longer episodes had a marked effect on total time exposure to extremes. The time differences in each of the three longest durations episodes (30, 60, and 120 seconds) were significantly less during automated than during manual control (p < 0.001). Nearly two-third of the reduction of total time spent at the extremes between automated and manual control (3.8 to 2.1% for < 80% SpO2 and 3.0 to 1.6% for > 98% SpO2) was seen in the episodes of at least 60 seconds. CONCLUSIONS: This study shows that the majority of episodes preterm infants spent in SpO2 extremes are of short duration regardless of manual or automated control. However, the infrequent longer episodes not only contribute the most to the total exposure, but also their reduction in frequency to the improvement associated with automated control.

Alberta Children's Hospital Neonatology Calgary Canada

Amsterdam Reproduction and Development Amsterdam The Netherlands

Czech Technical University Prague School of Biomedical Engineering Prague Czech Republic

Department of Neonatology University Hospital Tuebingen Germany

Emma Children's Hospital Department of Neonatology Amsterdam UMC Amsterdam Netherlands

James Cook University Hospital Neonatology South Tees NHS Trust Middlesbrough UK

Vittore Buzzi Children's Hospital Neonatology Milan Italy

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Hagadorn JJ, Sink DW, Buus-Frank ME, et al. Alarm safety and oxygen saturation targets in the Vermont Oxford Network iNICQ 2015 collaborative. J Perinatol. 2017;37:270–276. doi: 10.1038/jp.2016.219. PubMed DOI

van Zanten HA, Tan RN, Thio M, et al. The risk for hyperoxaemia after apnoea, bradycardia and hypoxaemia in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2014;99(4):F269–F273. doi: 10.1136/archdischild-2013-305745. PubMed DOI

Poets C, Roberts R, Schmidt B, et al. Association between intermittent hypoxemia or bradycardia and late death or disability in extremely preterm infants. JAMA. 2015;314(6):595–603. doi: 10.1001/jama.2015.8841. PubMed DOI

Askie LM, Henderson-Smart DJ, Irwig L, Simpson JM. Oxygen-saturation targets and outcomes in extremely preterm infants. NEJM. 2003;349:959–967. doi: 10.1056/NEJMoa023080. PubMed DOI

Mitra S, Singh B, El-Naggar W, McMillan DD. Automated versus manual control of inspired oxygen to target oxygen saturation in preterm infants: a systematic review and meta-analysis. J Perinatol. 2018;38(4):351–360. doi: 10.1038/s41372-017-0037-z. PubMed DOI

Abdo M, Hanbal A, Asla MM, et al. Automated versus manual oxygen control in preterm infants receiving respiratory support: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2021:1–8. PubMed

van Kaam AH, Hummler H, Wilinska M, et al. Automated versus manual oxygen control with different saturation targets and modes of respiratory support in preterm infants. J Pediatr. 2015;167(3):545–550. doi: 10.1016/j.jpeds.2015.06.012. PubMed DOI

van den Heuvel ME, van Zanten HA, Bachman T, et al. Optimal target range of closed-loop inspired oxygen support in preterm infants: a randomized controlled study. J Pediatr. 2018;197:36–41. doi: 10.1016/j.jpeds.2018.01.077. PubMed DOI

Claure N, Bancalari E, D’Ugard C, et al. Multicenter crossover study of automated control of inspired oxygen in ventilated preterm infants. Pediatrics. 2011;127(1):e76–e83. doi: 10.1542/peds.2010-0939. PubMed DOI

Lal M, Tin W, Sinha S. Automated control of inspired oxygen in ventilated preterm infants: crossover physiological study. Acta Paediatr. 2015;104(11):1084–1089. doi: 10.1111/apa.13137. PubMed DOI

Waitz M, Schmid MB, Fuchs H, et al. Effects of automated adjustment of the inspired oxygen on fluctuations of arterial and regional cerebral tissue oxygenation in preterm infants with frequent desaturations. J Pediatr. 2015;166(2):240–244. doi: 10.1016/j.jpeds.2014.10.007. PubMed DOI

Schmidt B, Whyte RK, Shah PS, et al. Effects of targeting higher or lower oxygen saturations in centers with more versus less separation between median saturations. J Pediatr. 2016;178:288–291. doi: 10.1016/j.jpeds.2016.08.002. PubMed DOI

Raffay TM, Dylag AM, Sattar A, et al. Neonatal intermittent hypoxemia events are associated with diagnosis of bronchopulmonary dysplasia at 36 weeks postmenstrual age. Pediatr Res. 2019;85(3):318–323. doi: 10.1038/s41390-018-0253-z. PubMed DOI PMC

Di Fiore J, Bloom J, Orge F, et al. A higher incidence of intermittent hypoxemic episodes is associated with severe retinopathy of prematurity. J Pediatr. 2010;157(1):69–73. doi: 10.1016/j.jpeds.2010.01.046. PubMed DOI PMC

Warakomska M, Bachman TE, Wilinska M. Evaluation of two SpO2 alarm strategies during automated FiO2 control in the NICU: a randomized crossover study. BMC Pediatr. 2019;19(1):142. doi: 10.1186/s12887-019-1496-5. PubMed DOI PMC

Bachman TE, Roubik K. Prevalence of potentially clinically relevant complex episodes of extreme SpO2 during manual and automatic control of inspired oxygen. Lek Tech. 2022;52(1):23–28.

Bachman TE, Newth CJL, Iyer NP, et al. Hypoxemic and hyperoxemic likelihood in pulse oximetry ranges: NICU observational study. Arch Dis Child Fetal Neonatal Ed. 2019;104(3):F274–F279. doi: 10.1136/archdischild-2017-314448. PubMed DOI

Stenson BJ. Achieved oxygenation saturations and outcome in extremely preterm infants. Clin Perinatol. 2019;46(3):601–610. doi: 10.1016/j.clp.2019.05.011. PubMed DOI

Performance and safety of the PRICO closed-loop oxygen saturation targeting system in neonates: pragmatic multicentre cross-over study (TarOx Study)