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To determine if the use of closed-loop automated oxygen control (CLAC) reduced the incidence and duration of hypoxemic episodes (SpOInfants were studied on two consecutive days for 6 h each day. They were randomised to receive standard care (manual oxygen control) or standard care with a CLAC system (automated oxygen control) first.Sixteen infants with a median (IQR) gestational age of 37.4 (36.6-38.8) weeks were studied at a median (IQR) postmenstrual age of 38.8 (37.4-39.8) weeks. During the automated oxygen control period, infants spent less time in hypoxemia (SpOClosed-loop automated oxygen control in ventilated infants born at or near term was associated with a reduction in the incidence and duration of hypoxemic episodes with more time spent in the target oxygen range.

There is a paucity of data concerning the efficacy of a second course of systemic postnatal corticosteroids resulting in a successful extubation of prematurely-born, ventilated infants and its effect on their respiratory function.To determine the efficacy of a second course of systemic dexamethasone in successful extubation of prematurely-born infants and to describe the respiratory function changes that occur following the administration of the second course.Retrospective cohort study of ventilated infants less than 30 weeks of gestation who received a nine-day second course of intravenous dexamethasone in a tertiary neonatal unit. Extubation was deemed successful if the infants were not re-intubated within 72 h of the extubation attempt. We calculated the ventilation perfusion ratio (VFifteen (10 male) infants with a median (IQR) gestational age (GA) of 25.7 (24.7-26.6) weeks and a birth weight of 0.79 (0.67-0.93) kg were studied at a postnatal age of 60 (48-73) days. Fourteen of fifteen infants (93%) were successfully extubated. The VA second course of systemic dexamethasone appears efficient in weaning premature infants off invasive ventilation and is associated with a significant improvement in oxygenation.

Background Many preterm infants require supplemental oxygen in the newborn period but experience frequent fluctuations of their oxygen saturation levels. Intermittent episodes of hypoxia or hyperoxia increase the risk of complications. Compliance with achievement of oxygen saturation targets is variable, and the need for frequent adjustments of the inspired oxygen concentration increases workload. Closed-loop automated oxygen control systems (CLAC) improve achievement of oxygen saturation targets and reduce both episodes of hypoxia and hyperoxia and the number of manual adjustments. This study investigates whether CLAC compared with manual oxygen control reduces the duration of mechanical ventilation in preterm infants born at less than 31 weeks of gestation. Methods This randomised controlled trial performed at a single tertiary neonatal unit is recruiting 70 infants born at less than 31 weeks of gestational age and within 48 h of initiation of mechanical ventilation. Infants are randomised to CLAC or manual oxygen control from recruitment until successful extubation. The primary outcome is the duration of mechanical ventilation, and secondary outcomes are the percentage of time spent within target oxygen saturation ranges, the time spent in hypoxia or hyperoxia, the number of manual adjustments required, the number of days on oxygen, the incidence of bronchopulmonary dysplasia and the length and cost of neonatal unit stay. The study is performed following informed parental consent and was approved by the Yorkshire and the Humber-Sheffield Research Ethics Committee (protocol version 1.1, 13 July 2021). Discussion This trial will investigate the effect of CLAC on the duration of mechanical ventilation, which is an important clinical outcome as prolonged mechanical ventilation is associated with important adverse outcomes, such as bronchopulmonary dysplasia. Trial registration ClinicalTrials.Gov NCT05030337. Registered on 17 August 2021

Hypoxia can adversely affect cognition, while socioeconomic deprivation has also been associated with impaired neurodevelopment in the newborn. We aimed to assess the impact of hypoxia and socioeconomic deprivation on the neurodevelopmental outcomes of preterm infants.Retrospective cohort study at a tertiary neonatal unit between 2015 and 2018. The motor, cognitive and language domain scores of the Bayley-III assessment were recorded at 24 months of corrected gestational age. The percentage of time with pulse oximetry (SpOA total of 93,767 data points from 80 infants (34 male) with a median (IQR) gestational age of 27.9(25.9-29.0) weeks and a birth weight of 0.94(0.74-1.23) kg were analysed. The median (IQR) motor score [103(91-110)] was significantly related to the median (IQR) time with SpOHypoxia in preterm infants exerted a negative impact on motor function and cognition and conversely, higher educational attainment had a positive impact on cognition and language.

Objective To describe the effect of systemic corticosteroids administered to treat evolving bronchopulmonary dysplasia on oxygen diffusion and ventilation efficiency. Study design This was a retrospective cohort study of ventilated infants who received a 9-day course of dexamethasone in a tertiary neonatal unit. We calculated the transcutaneous oxygen saturation–to–fraction of inspired oxygen (FiO2) ratio (SFR), the ventilation perfusion ratio (VA/Q), and the ventilation efficiency index (VEI) before, during, and after the course of corticosteroids. The response to corticosteroids was calculated as the difference between the FiO2 percentage before starting steroids and the lowest FiO2 value during the course of steroid treatment. Results Seventy infants (38 males) with a median gestational age (GA) of 25.0 weeks (IQR, 24.3-26.0 weeks) and a median birth weight of 0.70 kg (IQR, 0.63-0.82 kg) were studied at a median postnatal age of 39 days (IQR, 29-48 days). The median SFR before treatment was 1.42 (IQR, 1.19-1.72), and the highest SFR was 2.35 (IQR, 1.87-2.83) after 9 days of treatment. The median VA/Q before treatment was 0.14 (IQR, 0.11-0.18) and was significantly higher at 72 hours after the start of treatment (0.22; IQR, 0.15-0.29; P Conclusions Oxygen diffusion continues to improve throughout the entire duration of a 9-day course of systemically administered corticosteroids in ventilated extremely preterm infants. More immature infants are less responsive to corticosteroids.

We hypothesised that extremely premature infants would have decreased muscle mass at term-corrected age compared to term-born infants and that the degree of reduced muscle mass acquisition would correlate with the duration of invasive mechanical ventilation. The MRI brain scans of infants admitted in the neonatal unit at King's College Hospital between 1 January 2010 and 1 June 2016 were retrospectively reviewed. The coronal cross-sectional area of the left deltoid muscle (DCSA) was measured in 17 infants born 28 weeks of gestation and in 20 infants born at term. The prematurely born infants had a median (IQR) gestation age of 25 weeks (24-27) and the term infants 40 weeks (38-41). The duration of invasive mechanical ventilation for the prematurely born infants was 39 days (14-62) and that for the term infants 4 days (2-5), p 0.001. DCSA was smaller in prematurely born infants (median 189, IQR 176-223 mmOur results suggest that prolonged mechanical ventilation in infants admitted in neonatal intensive care is associated with reduced skeletal muscle mass acquisition. What is Known: • Prolonged mechanical ventilation in adult intensive care patients has been associated with skeletal muscle dysfunction and atrophy. • The cross-sectional area of the deltoid muscle has been used to evaluate muscle atrophy in infants with a previous branchial plexus birth injury. What is New: • Premature infants studied at term exhibit lower cross-sectional area of the deltoid muscle than their term counterparts. • Prolonged mechanical ventilation could be associated with skeletal muscle impairment.

Background Pulmonary dead space (VD) is an index of ventilation inhomogeneity and one of the determinants of the magnitude of tidal volume to maintain optimal blood gases. Aims To identify the determinants of VD in ventilated newborns and to investigate differences in VD between prematurely born and term infants and those prematurely born infants who did or did not develop bronchopulmonary dysplasia (BPD). Methods Sixty-one mechanically ventilated infants (15 term, 46 preterm) were studied at a median age of 8 (IQR 2–31) days; 32 of the preterm infants developed BPD. VD was determined from the difference between arterial and end tidal carbon dioxide (CO2) using a low dead space CO2 detector using the Bohr/Enghoff equation and was related to body weight (VD/kg) at the time of study. The time to peak tidal expiratory flow/expiratory time (TPTEF/TE) was measured during spontaneous breathing using a fixed orifice pneumotachograph. Results VD/kg was related to gestational age (r = − 0.285, p = 0.001), birth weight (r = − 0.356, p < 0.001), weight (r = − 0.316, p < 0.001) and postmenstrual age (r = − 0.205, p = 0.020) at measurement, days of ventilation (r = 0.322, p < 0.001) and TPTEF/TE (r = − 0.397, p = 0.003). The median VD/kg was higher in prematurely born infants [2.3 (IQR: 1.7–3.0) ml/kg] compared to term infants [1.5 (1.3–2.1) ml/kg, (p = 0.003)] and in premature infants that developed BPD [2.6 (IQR 1.8–3.4) ml/kg] compared to those who did not [1.7 (IQR 1.1–1.9) ml/kg], (p < 0.001). Conclusions Numerous factors influence pulmonary dead space and thus an optimum tidal volume will differ according to the underlying demographics and respiratory status.

Background: Accurate prediction of extubation outcome could result in a significant reduction of respiratory morbidity in premature neonates. Objectives: To assess whether the respiratory muscle time constant of relaxation (τ) predicted extubation outcome in mechanically ventilated, premature infants. Methods: Forty-six mechanically ventilated infants with a median gestational age of 26 (interquartile range [IQR] 25-29) weeks were prospectively studied. τ was calculated from the reciprocal of the slope of the decline in airway pressure as a function of time. Measurements of τ were done during 5-10 min of a spontaneous breathing test (SBT) prior to extubation. During the first and last minute of the SBT, τ1 and τ2, respectively, were assessed, and the difference between them was calculated (Δτ). Results: The median τ2 was significantly higher in infants whose extubation failed (20.7 [IQR 12.9-34.7] s/cm H2O) than in infants whose extubation succeeded (8.2 [IQR 6.2-17.8] s/cm H2O, p = 0.002). The median Δτ was significantly higher in infants whose extubation failed (10.3 [IQR 4.4-23.9] s/cm H2O) than in infants whose extubation succeeded (-1.63 [IQR -5.7 to 0.3] s/cm H2O, p = 0.001). Extubation failure was associated with τ2 (p = 0.011) and Δτ (p = 0.010) after correcting for postmenstrual age, patent ductus arteriosus, and intraventricular haemorrhage. Receiver operator characteristic curve analysis demonstrated that Δτ predicted extubation failure with an area under the curve of 0.937. A Δτ of +1.02 s/cm H2O predicted extubation failure with 94% sensitivity and 83% specificity. Conclusions: The respiratory muscle time constant of relaxation during an SBT was significantly greater in infants whose extubation failed and could be used to predict extubation outcome in prematurely born infants.

AIM To assess the respiratory muscle time constant of relaxation (τ), an index of respiratory muscle function in ventilated newborns. METHODS Sixty-two infants (42 born prematurely) with a median gestational age of 29 [interquartile range (IQR) 26-37] weeks were prospectively studied. Measurement of τ was taken during spontaneous breathing on endotracheal continuous positive airway pressure prior to extubation, and τ was calculated from the reciprocal of the slope of the airway pressure decline versus time. Infants were classified as having had systemic or respiratory infection (positive microbiology) if they had any positive bacterial blood or respiratory culture prior to measurement. RESULTS Measurement of τ was taken at a median post-natal age of 6 (IQR 3-29) days. The median τ was higher in premature infants [17.4 (IQR 7.7-28.3) sec/cmH2 O] compared to term infants [6.8 (IQR 4.4-8.7) sec/cmH2 O, p