Randomised crossover trial comparing algorithms and averaging times for automatic oxygen control in preterm infants.

Area of Science:

• Neonatal Medicine
• Respiratory Physiology
• Medical Technology

Background:

• Single programmed oxygen control (SPOC) using pulse oximetry (SpO2) saturation improves time within target saturation ranges for preterm infants.
• Previous SPOC algorithms lacked an upper fraction of inspired oxygen (FiO2) limit, potentially leading to suboptimal control.
• Optimizing SpO2 control is crucial for managing respiratory support in vulnerable preterm neonates.

Purpose of the Study:

• To evaluate if a revised SPOC algorithm (SPOCnew) with an upper FiO2 limit improves the percentage of time preterm infants spend within the SpO2 target range (Target%) compared to routine manual control (RMC) and a previous SPOC algorithm (SPOCold).
• To assess the impact of different SpO2 averaging times (2s and 8s) on SpO2 control during SPOC periods.

Main Methods:

• A randomized controlled crossover study was conducted in a tertiary neonatal intensive care unit.
• Twenty-four preterm infants on non-invasive respiratory support received 12-hour periods of SPOCnew and SPOCold, each with 6 hours of 2s and 8s averaging times, compared against 6-hour periods of RMC.
• The primary outcome measure was the percentage of time SpO2 remained within the predefined target range (Target%).

Main Results:

• Both SPOC algorithms (SPOCold and SPOCnew) resulted in a significantly higher Target% compared to RMC, irrespective of the averaging time used.
• SPOCnew achieved a Target% of 70% (2s averaging) and 72% (8s averaging), while SPOCold achieved 69% (2s) and 71% (8s), compared to 56% for RMC.
• The averaging time of the pulse oximeter did not significantly alter the effectiveness of SpO2 control under SPOC.

Conclusions:

• SPOC algorithms, including the revised version with an upper FiO2 limit, are superior to RMC in maintaining target SpO2 levels in preterm infants.
• The SPOCnew algorithm effectively controls SpO2 within the target range, even when an upper limit for FiO2 is imposed.
• The findings support the use of SPOC for optimizing oxygen therapy in neonatal intensive care, with averaging time having minimal impact.