SpO<sub>2</sub>and retinopathy of prematurity: state of the art

Martinelli, Stefano; Gatelli, Italo Francesco; Proto, A

doi:10.3109/14767058.2012.714982

The Journal of Maternal-Fetal & Neonatal Medicine

2012

DOI: 10.3109/14767058.2012.714982

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SpO₂and retinopathy of prematurity: state of the art

Stefano Martinelli

Italo Francesco Gatelli

A Proto

Abstract: Future randomized, controlled trials should be designed including a cohort of infants in which a more dynamic approach to saturation targeting is adopted, i.e. lower saturation levels in the first few weeks of life and higher saturation levels after the 32 weeks of PMA.

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“…The resulting reduction in hypoxemic episodes may be important in terms of potential sequelae of hypoxemic episodes in preterm infants. 1,3,[14][15][16] We assumed different conditions among study centers and aimed at detecting significant improvements concerning Target% for each single study by enrolling 18 infants per center. Unfortunately and despite considerable effort, we failed to reach this projected sample size in 3 of 4 centers.…”

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Closed-Loop Automatic Oxygen Control (CLAC) in Preterm Infants: A Randomized Controlled Trial

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: In preterm infants receiving supplemental oxygen, manual control of the inspired oxygen fraction is often difficult and time consuming, which may increase the risk of complications. We developed a system for automatic oxygen control and proved its efficacy in the past. WHAT THIS STUDY ADDS:A multicenter study adds evidence for the proposed automatic oxygen control system to significantly improve oxygen administration to preterm infants receiving mechanical ventilation or nasal continuous positive airway pressure while reducing workload compared with routine manual oxygen control. abstract BACKGROUND AND OBJECTIVE: In preterm infants receiving supplemental oxygen, routine manual control (RMC) of the fraction of inspired oxygen (FIO 2 ) is often difficult and time consuming. We developed a system for closed-loop automatic control (CLAC) of the FIO 2 and demonstrated its short-term safety and efficacy in a single-center study. The objective of this study was to test the hypothesis that this system is more effective than RMC alone in maintaining arterial oxygen saturation within target levels when evaluated over 24 hours under routine conditions and with different target levels. METHODS:We performed a multicenter, randomized controlled, crossover clinical trial in 34 preterm infants receiving mechanical ventilation or nasal continuous positive airway pressure and supplemental oxygen. Twenty-four-hour periods with RMC were compared with 24-hour periods of RMC supported by CLAC. RESULTS:The median (range) percentage of time with arterial oxygen saturation levels within target range was 61.4 (31.5-99.5) for RMC and 71.2 (44.0-95.4) for CLAC (P , .001). The median (range) number of manual FIO 2 adjustments was reduced from 77.0 (0.0-224.0) for RMC to 52.0 (10.0-317.0) for CLAC (P = .007).CONCLUSIONS: CLAC may improve oxygen administration to preterm infants receiving mechanical ventilation or nasal continuous positive airway pressure while reducing workload related to RMC. Pediatrics 2014;133:e379-e385 Preterm infants frequently require supplemental oxygen (O 2 ). The goal of this therapy is to deliver sufficient O 2 to the tissues while minimizing O 2 toxicity and oxidative stress, which may result from too high or too widely fluctuating O 2 levels. Although the optimal level of arterial pulse oximeter saturation (SpO 2 ) is still debated, there is evidence that wide fluctuations in SpO 2 should in any case be avoided. [1][2][3] This may be difficult to achieve, however, under routine clinical conditions. 4 Thus, automatic titration of the fraction of inspired oxygen (FIO 2 ) by using a closedloop FIO 2 controller (FIO 2 C) seems attractive. The first attempts at automating O 2 delivery to patients date back to the 1970s, but only recently, with the advance of motion-resistant pulse oximetry, sophisticated systems have been developed that seem to be suitable for clinical use in preterm infants requiring respiratory support. 5,6 In a group of preterm infants receiving nasal continuous posit...

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Closed-Loop Automatic Oxygen Control (CLAC) in Preterm Infants: A Randomized Controlled Trial

et al. 2014

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The Intertwined Paths of Retinopathy of Prematurity and Neonatal Intensive Care

Jain

2013

Clinics in Perinatology

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SpO₂and retinopathy of prematurity: state of the art

Abstract: Future randomized, controlled trials should be designed including a cohort of infants in which a more dynamic approach to saturation targeting is adopted, i.e. lower saturation levels in the first few weeks of life and higher saturation levels after the 32 weeks of PMA.

Cited by 2 publications

References 11 publications

Closed-Loop Automatic Oxygen Control (CLAC) in Preterm Infants: A Randomized Controlled Trial

Closed-Loop Automatic Oxygen Control (CLAC) in Preterm Infants: A Randomized Controlled Trial

The Intertwined Paths of Retinopathy of Prematurity and Neonatal Intensive Care

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SpO2and retinopathy of prematurity: state of the art

Abstract: Future randomized, controlled trials should be designed including a cohort of infants in which a more dynamic approach to saturation targeting is adopted, i.e. lower saturation levels in the first few weeks of life and higher saturation levels after the 32 weeks of PMA.

Cited by 2 publications

References 11 publications

Closed-Loop Automatic Oxygen Control (CLAC) in Preterm Infants: A Randomized Controlled Trial

Closed-Loop Automatic Oxygen Control (CLAC) in Preterm Infants: A Randomized Controlled Trial

The Intertwined Paths of Retinopathy of Prematurity and Neonatal Intensive Care

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Product

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SpO₂and retinopathy of prematurity: state of the art