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

Objectives: To investigate the impact of a pre-emptive apnoea triggered oxygen response on oxygen saturation (SpO ₂ ) targeting following central apnoea in preterm infants.
Design: Interventional crossover study of a 12-hour period of automated oxygen control with an apnoea response (AR) module, nested within a crossover study of a 24-hour period of automated oxygen control compared with aggregated data from two flanking 12-hour periods of manual control.
Setting: Neonatal intensive care unit PATIENTS: Preterm infants receiving non-invasive respiratory support and supplemental oxygen; median (IQR) birth gestation 27 (26-28) weeks, postnatal age 17 (12-23) days.
Intervention: Automated oxygen titration with an automated control algorithm modified to include an AR module. Alterations to inspired oxygen concentration (FiO ₂ ) were actuated by a motorised blender. Desired SpO ₂ range was 90-94%. Apnoea detection was by capsule pneumography.
Main Outcome Measures: Duration, magnitude and area under the curve (AUC) of SpO ₂ deviations following apnoea; frequency and duration of apnoeic events. Comparisons between periods of manual, automated and automated control with AR module.
Results: In 60 studies in 35 infants, inclusion of the AR module significantly reduced AUC for SpO ₂ deviations below baseline compared with both automated and manual control (manual: 87.1%±107.6% s, automated: 84.6%±102.8% s, AR module: 79.4%±102.7% s). However, there was a coincident increase in SpO ₂ overshoot (AUC (SpO ₂ >SpO _2(onset) ); manual: 44.3±99.9% s, automated: 54.7%±103.4% s, AR module: 65.7%±126.2% s).
Conclusion: Automated control with a pre-emptive apnoea-triggered FiO ₂ boost resulted in a modest reduction in post-apnoea hypoxaemia, but was followed by a greater SpO ₂ overshoot.
Trial Registration Number: ACTRN12616000300471.
Competing Interests: Competing interests: The University of Tasmania and Royal Hobart Hospital have jointly lodged a patent application concerning automated control of inspired oxygen concentration in the newborn infant. TJG and PAD are named inventors. The authors have no other conflicts of interest relevant to this article to disclose.
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