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Fitness to fly testing in term and ex-preterm babies without bronchopulmonary dysplasia
C J Bossley1, D Cramer, B Mason
1Royal Brompton Hospital, London, UK.
Insights
Ex-preterm infants without bronchopulmonary dysplasia (BPD) can safely fly, as fitness to fly tests show no increased risk. Feeding during simulated flight conditions causes a temporary drop in oxygen saturation (SpO2) but is not concerning.
Area of Science:
- Neonatal physiology
- Aerospace medicine
- Pediatric respiratory health
Background:
- Cabin pressurization during air travel reduces fraction of inspired oxygen (FiO2) to 0.15, potentially causing hypoxia.
- Hypoxia risk in infants with bronchopulmonary dysplasia (BPD) is known, but effects on ex-preterm infants without BPD were unclear.
- The impact of feeding during simulated flight conditions on infant oxygenation was also unknown.
Purpose of the Study:
- To assess the safety of air travel for ex-preterm infants without BPD.
- To evaluate the effect of feeding on oxygen saturation during simulated cabin conditions.
- To determine if routine pre-flight fitness testing is necessary for this population.
Main Methods:
- Fitness to fly tests were conducted on ex-preterm and term infants at 3 or 6 months corrected gestational age (CGA).
- Tests involved a body plethysmograph with FiO2 of 0.15 for 20 minutes, including a feeding period.
- A 'failed' test was defined as oxygen saturation (SpO2) <90% for at least 2 minutes.
Main Results:
- Both term and ex-preterm infants showed a significant median drop in SpO2 (-6%).
- No significant difference in SpO2 drop was observed between term and ex-preterm infants, or at 3 vs. 6 months CGA.
- Feeding led to a further SpO2 drop, with transient desaturation (<90%) in 22% of term and 32% of ex-preterm infants.
Conclusions:
- Ex-preterm infants without BPD at ≥3 months CGA are not at increased risk during air travel.
- Routine pre-flight fitness testing is not indicated for these infants.
- Feeding during simulated flight conditions causes a significant but transient decrease in SpO2.
Background:
During air flight, cabin pressurisation produces an effective fraction of inspired oxygen (FiO(2)) of 0.15. This can cause hypoxia in predisposed individuals, including infants with bronchopulmonary dysplasia (BPD), but the effect on ex-preterm babies without BPD was uncertain. The consequences of feeding a baby during the hypoxia challenge were also unknown.
Methods:
Ex-preterm (without BPD) and term infants had fitness to fly tests (including a period of feeding) at 3 or 6 months corrected gestational age (CGA) in a body plethysmograph with an FiO(2) of 0.15 for 20 min. A 'failed' test was defined as oxygen saturation (SpO(2)) <90% for at least 2 min.
Results:
41 term and 30 ex-preterm babies (mean gestational age 39.8 and 33.1 weeks, respectively) exhibited a significant median drop in SpO(2) (median -6%, p<0.0001); there was no difference between term versus ex-preterm babies, or 3 versus 6 months. Two term (5%) and two ex-preterm (7%) babies failed the challenge. The SpO(2) dropped further during feeding (median -4% in term and -2% in ex-preterm, p<0.0001), with transient desaturation (up to 30 s) <90% seen in 8/36 (22%) term and 9/28 (32%) ex-preterm infants; the ex-preterm babies desaturated more quickly (median 1 vs 3 min, p=0.002).
Conclusions:
Ex-preterm babies without BPD and who are at least 3 months CGA do not appear to be a particularly at-risk group for air travel, and routine preflight testing is not indicated. Feeding babies in an FiO(2) of 0.15 leads to a further fall in SpO(2), which is significant but transient.
