Intermittent Hypoxic Episodes in Preterm Infants: Do They Matter?

Martin, Richard J.; Wang, Katherine; Köroğlu, Özge Altun; Fiore, Juliann Di; Kc, Prabha

doi:10.1159/000329922

Cited by 207 publications

(201 citation statements)

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“…The average number of adjustments during resuscitation was similar in both groups (median 27, IQR (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) vs. 28 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36); P = 0.796). (Figure 1b), however the oxygen need was highly variable in both the automated (IQR (0.52-0.98)) and the manual group (IQR (0.37-0.72)).…”

Section: Resuscitationmentioning

confidence: 91%

“…Meeting SpO 2 targets affects morbidity and mortality, depending on the target range chosen (16-18). Beside overall SpO 2 targets, variability of oxygenation influences outcome of preterm infants (4,19,20). A promising solution to optimize oxygen therapy is the employment of an automatic "closed loop" system for regulation of FiO 2 based on SpO 2 .…”

Section: Translational Investigation Nature Publishing Groupmentioning

confidence: 99%

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Fully automated predictive intelligent control of oxygenation (PRICO) in resuscitation and ventilation of preterm lambs

et al. 2015

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Articles Translational Investigation nature publishing groupBackground: Hyperoxia and hypoxia influence morbidity and mortality of preterm infants. Automated closed-loop control of the fraction of inspired oxygen (FiO 2 ) has been shown to facilitate oxygen supplementation in the neonatal intensive care unit (NICU), but has not yet been tested during preterm resuscitation. We hypothesized that fully automated FiO 2 control based on predefined oxygen saturation (SpO 2 ) targets was applicable in both preterm resuscitation and ventilation. Methods: Twenty-two preterm lambs were operatively delivered and intubated in a modified EXIT procedure. They were randomized to receive standardized resuscitation with either automated or manual FiO 2 control, targeting SpO 2 according to the Dawson curve in the first 10 min and SpO 2 90-95% hereafter. Automated FiO 2 control also was applied during surfactant replacement therapy and subsequent ventilation. results: Time within target range did not differ significantly between manual and automated FiO 2 control during resuscitation, however automated FiO 2 control significantly avoided hyperoxia. Automated FiO 2 control was feasible during surfactant replacement and kept SpO 2 within target range significantly better than manual control during subsequent ventilation. conclusion: In our model, fully automated FiO 2 control was feasible in rapidly changing physiologic conditions during postnatal resuscitation and prevented hyperoxia. We conclude that closed loop FiO 2 control is a promising tool for the delivery room.o xygen supplementation is one of the most common therapeutic interventions in resuscitation and neonatal intensive care of term and preterm infants (1). However, both hypoxia and hyperoxia must be avoided because of their detrimental effects on morbidity and mortality in these children. While hypoxia may lead to direct and indirect cellular damage, hyperoxia has been associated with oxygen toxicity, oxidative stress (2), and chronic diseases of preterm infants such as bronchopulmonary dysplasia (3) and retinopathy of prematurity (4).Increase in oxygenation after birth is a gradual process (5). Measurement of oxygen saturation (SpO 2 ) by pulse oximetry in the delivery room is feasible in newborn resuscitation (6) and in preterm infants within the first minutes of life (7). SpO 2 reference values of preterm infants increase within the first 10 min of life (5). This has led to SpO 2 target values incorporated in the current European Resuscitation Council guidelines on resuscitation of newborns (8). In order to avoid hyperoxia, current recommendations advise resuscitation of preterm infants with a mixture of air and oxygen, and to use fraction of inspired oxygen (FiO 2 ) between 0.21 and 0.30 (9). FiO 2 should subsequently be titrated according to SpO 2 (10,11). General use of pulse oximetry has been shown to extensively reduce O 2 -derived toxicity in preterm infants (12). However, keeping SpO 2 manually within changing saturation limits during a hectic period of resu...

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Section: Resuscitationmentioning

confidence: 91%

Section: Translational Investigation Nature Publishing Groupmentioning

confidence: 99%

Fully automated predictive intelligent control of oxygenation (PRICO) in resuscitation and ventilation of preterm lambs

et al. 2015

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“…Regulating oxygen exposure is essential because hyperoxia is associated with retinopathy of prematurity and bronchopulmonary dysplasia, 1,2 whereas intermittent hypoxia is associated with increased mortality, severe retinopathy of prematurity, and pulmonary hypertension. [2][3][4][5][6][7] Continuous pulse oximetry (S pO 2 ) measured by new generation high-resolution pulse oximeters is more accurate than hand-transcribed S pO 2 values, and more episodes of intermittent hypoxia are detected. 8,9 Hence, high-resolution pulse oximetry with target O 2 ranges has been implemented in many neonatal ICUs to avoid fluctuations in S pO 2 and to reduce the risk of adverse outcomes.…”

Section: Introductionmentioning

confidence: 99%

The Objective Use of Pulse Oximetry to Predict Respiratory Support Transition in Preterm Infants: An Observational Pilot Study

2016

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BACKGROUND: Preterm infants often require some form of respiratory support with supplemental oxygen and are monitored by continuous pulse oximetry (S pO 2 ). The study objective was to determine whether the histogram distribution of S pO 2 over a 24-h period will predict readiness for weaning respiratory support in preterm infants. We hypothesize that infants with >15% of time spent with S pO 2 <86% before transitioning from CPAP or high-flow nasal cannula (HFNC) to low-flow nasal cannula, oxyhood, or room air are more likely to fail transitioning. METHODS: The S pO 2 histograms were downloaded daily for 31 infants, 24 -32 weeks gestational age, before transition from CPAP or HFNC to low-flow nasal cannula, oxyhood, or room air. The S pO 2 histogram downloads were continued for each infant for 1 week after transition or when the infant reached 36 weeks postmenstrual age or when S pO 2 monitoring was discontinued. Failure was defined as an increase in respiratory support within 72 h of transitioning. We compared the percentage of time for each S pO 2 quintile for the 24-h periods before and immediately following CPAP/HFNC transitioning between groups. RESULTS: Twenty-four subjects transitioned successfully, but 7 subjects failed. Two of 7 subjects (28.6%) who failed transition experienced S pO 2 <86% >15% of the time pretransition compared with none in the success group (P ‫؍‬ .045). The failure group experienced S pO 2 <86% 10.7 ؎ 11.9% of time pre-wean compared with 3.3 ؎ 4.7% of time in the success group (P ‫؍‬ .02). In contrast, infants who were successfully weaned tended to experience a greater percentage of time with S pO 2 >95% compared with the failure group, both pre-wean (54.3 ؎ 36.1% vs 33 ؎ 27.7%, P ‫؍‬ .16) and post-wean (52 ؎ 35.4% vs 27.4 ؎ 27.7%, P ‫؍‬ .10). CONCLUSIONS: These data suggest that pulse oximetry histograms may be useful in assessing CPAP/HFNC support transition readiness.

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“…The investigators reported that airway obstruction was not more common in the car seat, although there were fewer central apneas in the cot compared with the car seat overall. In extremely low birth weight infants, intermittent hypoxemia (defined as an acute decrease of 10% of saturated oxygen from stable baseline values for ≥5 s) tends to increase over the first four weeks of life, followed by plateau and eventual decline (14,15), lending further evidence to the theory of maturation originating centrally. Our finding that greater postnatal age was predictive of passing the car seat test supports this mechanism.…”

Section: Data Presented As Mean ± Sd or N (%) Unless Otherwise Indicatedmentioning

confidence: 87%

Factors associated with car seat test failure in late preterm infants: A retrospective chart review

2016

Paediatrics and Child Health

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B oth the Canadian Paediatric Society and the AmericanAcademy of Pediatrics recommend a "car seat challenge" for preterm infants (<37 weeks' gestational age [GA]) before discharge from the hospital (1,2). Additional criteria often include full-term infants with significant neurological or cardiorespiratory disorders (3-5). Testing has been recommended in these populations following studies performed in the 1980s, which found that preterm neonates experienced periods of oxygen desaturation when placed in a semi-upright position, which persisted but improved once placed supine (6,7). In 1993, Bass et al (8) collected data over a 15-month period following implementation of a 90 min car seat test for all preterm infants in their level 2 nursery. Sixteen of 87 (18.4%) infants had abnormal results (the majority of which were desaturations <89%). This sample included seven of 33 (21.2%) infants of 36 weeks' GA (8). A more recent study identified that late preterm infants (LPIs, infants 34 0/7 to 36 6/7 weeks' GA) have higher failure rates than preterm infants with lower GAs (9). The hypothesis for increased failure rates is that LPIs are tested at younger postnatal ages, allowing less time for physiological maturation. Second, infants born more preterm are usually admitted to the neonatal intensive care unit (NICU), undergo prolonged periods of monitoring, and are tested when stable and ready for BACKgROunD: Professional organizations recommend car seat testing of preterm infants before discharge from hospital. Late preterm infants (LPIs, 34 0/7 to 36 6/7 weeks' gestational age) are at the greatest risk for failure, despite often being well. OBJECTIVE: To determine the incidence of car seat testing failure in LPIs and associative factors. METHODS: A retrospective chart review was performed of inborn LPIs admitted to all levels of newborn care between July 1, 2012 and June 30, 2013. Data collected included maternal demographics, labour and delivery history, and neonatal course. Data were analyzed using backward logistic regression. RESuLTS: A total of 511 charts were reviewed and 367 LPIs were eligible for inclusion. Of the 313 LPIs tested (mean [± SD] gestational age 36 weeks ±6 days and birth weight 2614±405 g), 80 (26%) failed (95% CI 21% to 31% Ideally, infants should be tested after an appropriate transitional period. The authors identified factors that may be important in designing future, prospective studies in this area. Future research should evaluate the clinical significance of car seat testing and resource utilization.

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Intermittent Hypoxic Episodes in Preterm Infants: Do They Matter?

Cited by 207 publications

References 108 publications

Fully automated predictive intelligent control of oxygenation (PRICO) in resuscitation and ventilation of preterm lambs

Fully automated predictive intelligent control of oxygenation (PRICO) in resuscitation and ventilation of preterm lambs

The Objective Use of Pulse Oximetry to Predict Respiratory Support Transition in Preterm Infants: An Observational Pilot Study

Factors associated with car seat test failure in late preterm infants: A retrospective chart review

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