The risk for hyperoxaemia after apnoea, bradycardia and hypoxaemia in preterm infants

Zanten, Henriëtte A. van; Tan, Ratna N G B; Thió, Marta; Ginkel, Janneke M. de Man‐van; Zwet, Erik W. van; Lopriore, Enrico; Pas, Arjan B. te

doi:10.1136/archdischild-2013-305745

Cited by 50 publications

(36 citation statements)

References 19 publications

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“…The number of episodes of SpO 2 <80% that were followed by an SpO 2 overshoot did not differ between automated and manual control in the high (6 [2-16] vs 5 [1][2][3][4][5][6][7][8][9][10][11][12][13][14]) and low (8 vs 7 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]) SpO 2 target range.…”

Section: Resultsmentioning

confidence: 99%

“…Increased frequency of fluctuations in oxygenation with the lower SpO 2 target ranges has been reported. 10 It is possible that the FiO 2 increases in response to hypoxemia might have been unnecessarily long resulting in hyperoxemia 11 or that some degree of tolerance of high SpO 2 existed during manual control in an attempt to prevent or attenuate the episodes of hypoxemia.…”

Section: Discussionmentioning

confidence: 98%

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Automated versus Manual Oxygen Control with Different Saturation Targets and Modes of Respiratory Support in Preterm Infants

Kaam

Hummler²,

Wilińska

et al. 2015

The Journal of Pediatrics

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

Automated versus Manual Oxygen Control with Different Saturation Targets and Modes of Respiratory Support in Preterm Infants

Kaam

Hummler²,

Wilińska

et al. 2015

The Journal of Pediatrics

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“…In other occasions, the increase in FiO 2 in response to the episode of hypoxemia is not returned to baseline soon enough after the episode resolves, which also leads to hyperoxemia. (15) Contrary to expectations, the fluctuations in oxygenation increase after the acute phase of respiratory failure. The frequency of hypoxemia episodes is higher with advancing postnatal age, (16) and these episodes are more prevalent in infants with chronic lung disease.…”

Section: Introductionmentioning

confidence: 66%

Oxygen Saturation Targeting by Automatic Control of Inspired Oxygen in Premature Infants

Claure

Bancalari

2015

NeoReviews

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Maintenance of oxygen saturation targets and avoidance of extreme high and low levels of oxygenation in premature infants are difficult because of their respiratory instability and staff time limitations. Automated control of inspired oxygen is being proposed as a strategy to improve oxygenation targeting in these infants. This article presents the factors that affect oxygenation targeting, describes the systems for closed-loop control of oxygen, and discusses the evidence on their efficacy and limitations.

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“…To limit the duration and severity of these episodes, caregivers commonly provide increased oxygen to these patients during the episodes. This increase in oxygen is many times excessive and continues after resolution of the episode, resulting in rebound hyperoxemia [4]. Therefore, infants with frequent HE spend considerable time with arterial oxygen saturation (SpO 2 ) in the ranges of hypoxemia or hyperoxemia [5].…”

Section: Introductionmentioning

confidence: 99%

Hypoxemia Episodes during Day and Night and Their Impact on Oxygen Saturation Targeting in Mechanically Ventilated Preterm Infants

et al. 2017

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Background: Hypoxemia episodes (HE) occur frequently in ventilated preterm infants and hinder the achievement of arterial oxygen saturation (SpO₂) targets. These episodes may increase the risk for retinopathy of prematurity and neurodevelopmental disability. There are no data on the variation in HE and SpO₂ targeting between day and night. Objective: The aim of this study was to evaluate the difference between day and night on the frequency and severity of HE and achievement of SpO₂ targets. Methods: Twenty-four mechanically ventilated preterm infants with ≥4 episodes of SpO₂ <75% over an 8-h period were enrolled. The fraction of inspired oxygen (FiO₂), SpO₂, and ventilator parameters were recorded over 24 h. Data from the day (9 a.m. to 5 p.m.) were compared to the night (9 p.m. to 5 a.m.) for the frequency of HE and proportion of time within and outside the target SpO₂ range (90-95%). Results: The frequency of severe HE (SpO₂ <75, ≥20 s) and prolonged severe HE (SpO₂ <75, ≥60 s) was lower during the night compared to the day (1.6 ± 1.0 vs. 2.4 ± 1.3 episodes/h, p = 0.008, and 0.53 ± 0.35 vs. 0.90 ± 0.54 episodes/h, p = 0.018). There was no difference in mean episode duration. The frequency and duration of mild HE (SpO₂ <85, ≥20 s) were lower during the night compared to the day (5.9 ± 2.7 vs. 7.1 ± 2.5 episodes/h, p = 0.003, and 72 ± 15 vs. 87 ± 25 s, p = 0.01, respectively). The proportion of time in severe hypoxemia (SpO₂ <75%) was smaller, whereas time in hyperoxemia (SpO₂ >95%) was greater, during the night compared to the day. The mean FiO₂ did not differ between day and night. Conclusion: In this group of infants with frequent HE, nighttime was associated with fewer episodes when compared to daytime. This is likely due to less handling and sensory stimulation during the night. The increase in time spent with hyperoxemia during the night is likely to be due to more tolerance of high SpO₂ with less proactive weaning of FiO₂.

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The risk for hyperoxaemia after apnoea, bradycardia and hypoxaemia in preterm infants

Abstract: In preterm infants supported with nCPAP in the neonatal intensive care unit (NICU), SpO₂ ≥95% frequently occurred when oxygen was increased for ABCs and lasted longer than the bradycardia and SpO₂ ≤80%.

Cited by 50 publications

References 19 publications

Automated versus Manual Oxygen Control with Different Saturation Targets and Modes of Respiratory Support in Preterm Infants

Automated versus Manual Oxygen Control with Different Saturation Targets and Modes of Respiratory Support in Preterm Infants

Oxygen Saturation Targeting by Automatic Control of Inspired Oxygen in Premature Infants

Hypoxemia Episodes during Day and Night and Their Impact on Oxygen Saturation Targeting in Mechanically Ventilated Preterm Infants

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