The effect of automated oxygen control on clinical outcomes in preterm infants: a pre- and post-implementation cohort
H H Salverda1, N J Oldenburger2, M Rijken2
1Division of Neonatology, Department of Paediatrics, Leiden University Medical Center, PO box 9600, 2300 RC, Leiden, The Netherlands. H.H.Salverda@lumc.nl.
Insights
Automated oxygen control (AOC) in preterm infants did not change mortality or complications. However, it reduced invasive ventilation duration, showing a shift towards non-invasive support in neonatal intensive care units.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Respiratory Support
Background:
- Oxygen saturation deviations are linked to mortality and morbidities in preterm infants.
- Automated oxygen control (AOC) improves time within target oxygen saturation ranges.
Purpose of the Study:
- To compare clinical outcomes in preterm infants before and after implementing AOC as standard care.
- To evaluate the impact of AOC on mortality, prematurity complications, ventilation duration, and NICU length of stay.
Main Methods:
- Retrospective pre-post implementation cohort study.
- Inclusion of preterm infants (24-29 weeks gestational age) receiving respiratory support.
- Comparison of outcomes between infants before (2012-2015) and after (2015-2018) AOC implementation.
Main Results:
- No significant differences in mortality or prematurity complications between cohorts.
- Shorter duration of invasive ventilation in the AOC group (4.7 days) compared to the pre-AOC group (6.4 days).
- No difference in Neonatal Intensive Care Unit (NICU) length of stay, but a trend towards increased non-invasive ventilation post-implementation.
Conclusions:
- Implementation of AOC as standard care did not alter mortality or morbidity in preterm infants during admission.
- AOC use was associated with a reduction in invasive ventilation days.
- A shift towards non-invasive ventilation strategies was observed after AOC implementation.
Abstract:
Several studies demonstrated an increase in time spent within target range when automated oxygen control (AOC) is used. However the effect on clinical outcome remains unclear. We compared clinical outcomes of preterm infants born before and after implementation of AOC as standard of care. In a retrospective pre-post implementation cohort study of outcomes for infants of 24-29 weeks gestational age receiving respiratory support before (2012-2015) and after (2015-2018) implementation of AOC as standard of care were compared. Outcomes of interest were mortality and complications of prematurity, number of ventilation days, and length of stay in the Neonatal Intensive Care Unit (NICU). A total of 588 infants were included (293 pre- vs 295 in the post-implementation cohort), with similar gestational age (27.8 weeks pre- vs 27.6 weeks post-implementation), birth weight (1033 grams vs 1035 grams) and other baseline characteristics. Mortality and rate of prematurity complications were not different between the groups. Length of stay in NICU was not different, but duration of invasive ventilation was shorter in infants who received AOC (6.4 ± 10.1 vs 4.7 ± 8.3, p = 0.029).Conclusion: In this pre-post comparison, the implementation of AOC did not lead to a change in mortality or morbidity during admission. What is Known: • Prolonged and intermittent oxygen saturation deviations are associated with mortality and prematurity-related morbidities. • Automated oxygen controllers can increase the time spent within oxygen saturation target range. What is New: • Implementation of automated oxygen control as standard of care did not lead to a change in mortality or morbidity during admission. • In the period after implementation of automated oxygen control, there was a shift toward more non-invasive ventilation.
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