The effect of automated oxygen control on clinical outcomes in preterm infants: a pre- and post-implementation cohort study

Abstract

Several studies demonstrated an increase in time spent within target range when automated oxygen control (AOC) is used. However the effect on clinical outcome remains unclear. We compared clinical outcomes of preterm infants born before and after implementation of AOC as standard of care. In a retrospective pre-post implementation cohort study of outcomes for infants of 24–29 weeks gestational age receiving respiratory support before (2012–2015) and after (2015–2018) implementation of AOC as standard of care were compared. Outcomes of interest were mortality and complications of prematurity, number of ventilation days, and length of stay in the Neonatal Intensive Care Unit (NICU). A total of 588 infants were included (293 pre- vs 295 in the post-implementation cohort), with similar gestational age (27.8 weeks pre- vs 27.6 weeks post-implementation), birth weight (1033 grams vs 1035 grams) and other baseline characteristics. Mortality and rate of prematurity complications were not different between the groups. Length of stay in NICU was not different, but duration of invasive ventilation was shorter in infants who received AOC (6.4 ± 10.1 vs 4.7 ± 8.3, p = 0.029).Conclusion: In this pre-post comparison, the implementation of AOC did not lead to a change in mortality or morbidity during admission. What is Known:• Prolonged and intermittent oxygen saturation deviations are associated with mortality and prematurity-related morbidities.• Automated oxygen controllers can increase the time spent within oxygen saturation target range.What is New:• Implementation of automated oxygen control as standard of care did not lead to a change in mortality or morbidity during admission.• In the period after implementation of automated oxygen control, there was a shift toward more non-invasive ventilation.

The Intertemporal Role of Respiratory Support in Improving Neonatal Outcomes: A Narrative Review

“…In a retrospective cohort study in which clinical outcomes of preterm infants were evaluated before and after the implementation of automated oxygen control as the standard of care, invasive ventilation was significantly shorter in infants who received automated oxygen control. There was no difference, however, in the length of stay in the NICU, mortality, or morbidity during the study periods [64]. On the contrary, in another retrospective cohort study, improvement in rates of mortality, any ROP, ROP requiring treatment, and BPD was reported after implementation of a specific novel oxygen management strategy [65].…”

Premature Birth, Management, Complications

“…Bacterial products and/or profibrous cytokines acting on cervical cells of the uterus may cause a change of MMPs expression. High concentrations MMP-8 of amniotic fluid are associated with PB (before the 32nd week of pregnancy) so induction of uterine contractions (directly or by functional "withdrawal" of progesterone) [50][51][52][53][54][55][56][57][58][59][60].…”

“…The receptor antagonist of IL-1 inhibits the biological effects of IL-1, blocking its receptors. Consequently reduction of IL-1 production and induced from that of prostaglandin production by them endometrial tissue can prevent PB associated with infection Il-1β is found in chorionic villi, decidua, amniotic fluid and placental cultures [50][51][52][53][54][55][56][57][58][59][60]. Elevated levels of Il-6 are usually found in the amniotic fluid, with inflammation.…”

“…The finding of extremelly high levels of the specific cytokine in the amniotic fluid pregnant women who presented with some kind of inflammation and its very low concentration in cases of PB "idiopathic" etiology, make it one of the most sensitive and specific PB indicators On the contrary, they were found to be reduced in cases of premature birth. Il-10 is also elevated in amniotic fluid after amniocentesis during the second trimester in pregnancies with IUGR and chorioamnionitis [50][51][52][53][54][55][56][57][58][59][60]. Interleukin-10 (IL-10) is known to be major inhibitory cytokine in the process synthesis of cytokines by both T cells (interferon-γ and IL-2), as well as by monocytes macrophages (TNF-α, IL-6, IL-8, and IL-12) and as therefore plays an important role in achieving the outcome of the pregnancy by securing the maternity tolerance to the allogeneic fetus.…”

“…Interleukin-10 (IL-10) is known to be major inhibitory cytokine in the process synthesis of cytokines by both T cells (interferon-γ and IL-2), as well as by monocytes macrophages (TNF-α, IL-6, IL-8, and IL-12) and as therefore plays an important role in achieving the outcome of the pregnancy by securing the maternity tolerance to the allogeneic fetus. In most pregnancies IL-10 is detected in amniotic fluid Its high levels in amniotic fluid of pregnancies complicated with residual embryonic development as well as in cases of pregnant women with clinical symptoms chorioamnionitis associated with dysfunctional for immune activity in pregnancy and in PB [50][51][52][53][54][55][56][57][58][59][60].…”