• Anton H van Kaam, Helmut D Hummler, Maria Wilinska, Janusz Swietlinski, Mithilesh K Lal, Arjan B te Pas, Gianluca Lista, Samir Gupta, Carlos A Fajardo, Wes Onland, Markus Waitz, Malgorzata Warakomska, Francesco Cavigioli, Eduardo Bancalari, Nelson Claure, and Thomas E Bachman.
• Emma Children's Hospital AMC, Amsterdam, The Netherlands.
• J. Pediatr. 2015 Sep 1;167(3):545-50.e1-2.

ObjectiveTo determine the efficacy and safety of automated adjustment of the fraction of inspired oxygen (FiO2) in maintaining arterial oxygen saturation (SpO2) within a higher (91%-95%) and a lower (89%-93%) target range in preterm infants.Study DesignEighty preterm infants (gestational age [median]: 26 weeks, age [median] 18 days) on noninvasive (n = 50) and invasive (n = 30) respiratory support with supplemental oxygen, were first randomized to one of the SpO2 target ranges and then treated with automated FiO2 (A-FiO2) and manual FiO2 (M-FiO2) oxygen control for 24 hours each, in random sequence.ResultsThe percent time within the target range was higher during A-FiO2 compared with M-FiO2 control. This effect was more pronounced in the lower SpO2 target range (62 ± 17% vs 54 ± 16%, P < .001) than in the higher SpO2 target range (62 ± 17% vs 58 ± 15%, P < .001). The percent time spent below the target or in hypoxemia (SpO2 <80%) was consistently reduced during A-FiO2, independent of the target range. The time spent above the target range or at extreme hyperoxemia (SpO2 >98%) was only reduced during A-FiO2 when targeting the lower SpO2 range (89%-93%). These outcomes did not differ between infants on noninvasive and invasive respiratory support. Manual adjustments were significantly reduced during A-FiO2 control.ConclusionsA-FiO2 control improved SpO2 targeting across different SpO2 ranges and reduced hypoxemia in preterm infants on noninvasive and invasive respiratory support.Trial RegistrationISRCTN 56626482.Copyright © 2015 Elsevier Inc. All rights reserved.

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