• Colm P Travers, Waldemar A Carlo, Arie Nakhmani, Shweta Bhatia, Samuel J Gentle, VenkataNagaSai Apurupa Amperayani, Premananda Indic, Inmaculada Aban, and Namasivayam Ambalavanan.
• Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL. Electronic address: ctravers@peds.uab.edu.
• J. Pediatr. 2018 Sep 1; 200: 98-103.

ObjectiveTo test the hypothesis that environmental compared with nasal cannula oxygen decreases episodes of intermittent hypoxemia (oxygen saturations <85% for ≥10 seconds) in preterm infants on supplemental oxygen by providing a more stable hypopharyngeal oxygen concentration.Study DesignThis was a single center randomized crossover trial with a 1:1 parallel allocation to order of testing. Preterm infants on supplemental oxygen via oxygen environment maintained by a servo-controlled system or nasal cannula with flow rates ≤1.0 L per kg per minute were crossed over every 24 hours for 96 hours. Data were collected electronically to capture real time numeric and waveform data from patient monitors.ResultsTwenty-five infants with gestational age of 27 ± 2 weeks (mean ± SD) and a birth weight of 933 ± 328 g were studied at postnatal day 36 ± 26. The number of episodes of intermittent hypoxemia per 24 hours was 117 ± 77 (median, 98; range, 4-335) with oxygen environment vs 130 ± 63 (median, 136; range, 16-252) with nasal cannula (P = .002). Infants on oxygen environment compared with nasal cannula also had decreased episodes of severe intermittent hypoxemia (P = .005). Infants on oxygen environment compared with nasal cannula had a lower proportion of time with oxygen saturations <85% (.05 ± .03 vs .06 ± .03, P < .001), and a lower coefficient of variation of oxygen saturation (P = .02).ConclusionsIn preterm infants receiving supplemental oxygen, servo-controlled oxygen environment decreases hypoxemia compared with nasal cannula.Trial RegistrationClinicalTrials.gov: NCT02794662.Copyright © 2018 Elsevier Inc. All rights reserved.

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