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Apnoea-triggered increase in fraction of inspired oxygen in preterm infants: a randomised cross-over study

Andrew Marshall1, Oliver J Ladlow2, Charlotte Bannink2

  • 1School of Engineering, College of Sciences and Engineering, University of Tasmania, Hobart, Tasmania, Australia andrew.marshall@utas.edu.au.

Archives of Disease in Childhood. Fetal and Neonatal Edition
|August 28, 2023
PubMed

Insights

Automated oxygen control with an apnoea response module modestly reduced hypoxemia in preterm infants. However, this intervention also led to increased oxygen saturation (SpO2) overshoot following apnoea.

Area of Science:

  • Neonatal medicine
  • Respiratory physiology
  • Medical technology

Background:

  • Preterm infants often experience central apnoea, leading to potentially harmful fluctuations in oxygen saturation (SpO2).
  • Automated oxygen control systems aim to maintain target SpO2 levels, but their efficacy during apnoeic events requires further investigation.

Purpose of the Study:

  • To evaluate the impact of a pre-emptive apnoea-triggered oxygen response on SpO2 targeting in preterm infants experiencing central apnoea.
  • To compare the effectiveness of automated oxygen control with and without an apnoea response (AR) module against manual control.

Main Methods:

  • An interventional crossover study involving preterm infants receiving non-invasive respiratory support and supplemental oxygen.
  • Automated oxygen titration using a motorized blender, with an AR module designed to detect apnoea via capsule pneumography and adjust inspired oxygen concentration (FiO2).
  • SpO2 deviations, apnoea frequency, and duration were measured and compared across manual, automated, and automated with AR module control periods.

Main Results:

  • The AR module significantly reduced the area under the curve (AUC) of SpO2 deviations below baseline compared to both automated and manual control.
  • Despite reducing hypoxemia, the AR module was associated with a notable increase in SpO2 overshoot (AUC of SpO2 > SpO2(onset)).

Conclusions:

  • A pre-emptive, apnoea-triggered FiO2 boost in automated oxygen control offers a modest benefit in reducing post-apnoea hypoxemia in preterm infants.
  • The observed increase in SpO2 overshoot necessitates careful consideration of the overall impact and potential risks of this intervention.
Abstract

Keywords:
Intensive Care Units, NeonatalNeonatologyRespiratory MedicineTechnology

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