Optimal Target Range of Closed-Loop Inspired Oxygen Support in Preterm Infants: A Randomized Cross-Over Study

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Respiratory Physiology

Background:

• Oxygen-dependent infants often require precise oxygen monitoring and control.
• Automated fraction of inspired oxygen (A-FiO2) systems aim to maintain target oxygen saturation (SpO2) levels.
• Variability in SpO2 can lead to adverse outcomes in preterm infants.

Purpose of the Study:

• To evaluate the impact of different SpO2 target ranges during A-FiO2 on time spent within alarm limits.
• To determine if narrower SpO2 targets reduce hypoxemia without increasing hyperoxemia in infants.

Main Methods:

• A randomized crossover study involving 41 preterm infants on noninvasive respiratory support.
• Three SpO2 target ranges (86%-94%, 88%-92%, 89%-91%) were applied via A-FiO2 for 24 hours each.
• SpO2 levels were manually controlled during 24-hour washout periods between target range changes.

Main Results:

• All A-FiO2 target ranges resulted in similar time spent within the 86%-94% SpO2 alarm range (74%).
• Time in severe hypoxemia (SpO2 <80%) was significantly reduced with narrower target ranges (88%-92% and 89%-91%) compared to the widest range (86%-94%).
• No significant differences in hyperoxemia were observed between the tested target ranges.

Conclusions:

• Narrowing the A-FiO2 target range to ±2% around the desired median SpO2 effectively reduces time spent in hypoxemia.
• This strategy minimizes hypoxemia without elevating the risk of hyperoxemia in oxygen-dependent preterm infants.