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Control of breathing in preterm infants on incubator oxygen or nasal cannula oxygen

Colm P Travers1, Rouba Chahine2,3, Arie Nakhmani4

  • 1Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA. cptravers@uabmc.edu.

Pediatric Research
|August 15, 2024
PubMed

Insights

Incubator oxygen did not reduce intermittent hypoxemia in preterm infants but did decrease time with low oxygen saturation and abdominal hypoxemia. Higher carbon dioxide levels were observed with incubator oxygen, potentially improving respiratory stability.

Area of Science:

  • Neonatal Medicine
  • Respiratory Physiology
  • Pediatric Critical Care

Background:

  • Supplemental oxygen is crucial for preterm infants.
  • Different delivery methods, like incubator oxygen and nasal cannula oxygen, have varying effects on respiratory stability.
  • Optimizing oxygen delivery is essential for preventing complications in vulnerable preterm neonates.

Purpose of the Study:

  • To compare the efficacy of incubator oxygen versus nasal cannula oxygen in improving respiratory stability in preterm infants.
  • To assess the impact of each oxygen delivery method on intermittent hypoxemia, bradycardia, and tissue oxygenation.
  • To investigate the role of end-tidal carbon dioxide levels in respiratory control under different oxygenation strategies.

Main Methods:

  • A single-center randomized cross-over trial was conducted involving preterm infants (<29 weeks' gestation) requiring supplemental oxygen.
  • Infants were switched every 24 hours for 96 hours between incubator oxygen and nasal cannula oxygen (≤1.0 L/kg/min).
  • Key outcome measures included episodes of intermittent hypoxemia (SpO2 <85%), bradycardia, cerebral and abdominal hypoxemia, and end-tidal carbon dioxide.

Main Results:

  • No significant differences were found in episodes of intermittent hypoxemia, bradycardia, or cerebral hypoxemia between incubator and nasal cannula oxygen.
  • Incubator oxygen use was associated with fewer episodes of abdominal hypoxemia and reduced time spent with SpO2 <85%.
  • Infants on incubator oxygen exhibited higher end-tidal carbon dioxide levels compared to those on nasal cannula oxygen.

Conclusions:

  • Incubator oxygen did not reduce intermittent hypoxemia but improved other measures of respiratory stability in preterm infants.
  • Elevated carbon dioxide levels during incubator oxygen therapy may contribute to improved respiratory stability.
  • The mode of oxygen administration can influence breathing control in preterm infants through effects on oxygen stability and CO2 levels.
Abstract

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