Prolonged use of closed-loop inspired oxygen support in preterm infants: a randomised controlled trial
Language English Country England, Great Britain Media electronic
Document type Randomized Controlled Trial, Journal Article
PubMed
37827816
DOI
10.1136/archdischild-2023-325831
PII: archdischild-2023-325831
Knihovny.cz E-resources
- Keywords
- Intensive Care Units, Neonatal, Neonatology, Respiratory Medicine,
- MeSH
- Hypoxia prevention & control MeSH
- Cross-Over Studies MeSH
- Infant MeSH
- Oxygen * MeSH
- Humans MeSH
- Infant, Premature * MeSH
- Infant, Newborn MeSH
- Birth Weight MeSH
- Check Tag
- Infant MeSH
- Humans MeSH
- Infant, Newborn MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
- Names of Substances
- Oxygen * MeSH
OBJECTIVE: This randomised study in preterm infants on non-invasive respiratory support investigated the effectiveness of automated oxygen control (A-FiO2) in keeping the oxygen saturation (SpO2) within a target range (TR) during a 28-day period compared with manual titration (M-FiO2). DESIGN: A single-centre randomised control trial. SETTING: A level III neonatal intensive care unit. PATIENTS: Preterm infants (<28 weeks' gestation) on non-invasive respiratory support. INTERVENTIONS: A-FiO2 versus M-FiO2 control. METHODS: Main outcomes were the proportion of time spent and median area of episodes in the TR, hyperoxaemia, hypoxaemia and the trend over 28 days using a linear random intercept model. RESULTS: 23 preterm infants (median gestation 25.7 weeks; birth weight 820 g) were randomised. Compared with M-FiO2, the time spent within TR was higher in the A-FiO2 group (68.7% vs 48.0%, p<0.001). Infants in the A-FiO2 group spent less time in hyperoxaemia (13.8% vs 37.7%, p<0.001), but no difference was found in hypoxaemia. The time-based analyses showed that the A-FiO2 efficacy may differ over time, especially for hypoxaemia. Compared with the M-FiO2 group, the A-FiO2 group had a larger intercept but with an inversed slope for the daily median area below the TR (intercept 70.1 vs 36.3; estimate/day -0.70 vs 0.69, p<0.001). CONCLUSION: A-FiO2 control was superior to manual control in keeping preterm infants on non-invasive respiratory support in a prespecified TR over a period of 28 days. This improvement may come at the expense of increased time below the TR in the first days after initiating A-FiO2 control. TRIAL REGISTRATION NUMBER: NTR6731.
Amsterdam Public Health Research Institute Amsterdam the Netherlands
Amsterdam Reproduction and Development Amsterdam the Netherlands
Czech Technical University Prague Praha Czech Republic
Department of Medical Informatics University of Amsterdam Amsterdam the Netherlands
Department of Neonatology Emma Children's Hospital Amsterdam UMC Amsterdam the Netherlands
Department of Pediatrics and Neonatology OLVG Amsterdam the Netherlands
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