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Fitness to fly testing in term and ex-preterm babies without bronchopulmonary dysplasia
  1. C J Bossley1,
  2. D Cramer1,
  3. B Mason2,
  4. A Hayward3,
  5. J Smyth4,
  6. A McKee1,
  7. R Biddulph3,
  8. E Ogundipe3,
  9. A Jaffé2,
  10. I M Balfour-Lynn1,4
  1. 1Royal Brompton Hospital, London, UK
  2. 2Department of Paediatric Respiratory Medicine, Sydney Children's Hospital, Sydney, New South Wales, Australia
  3. 3Department of Neonatal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia
  4. 4Department of Neonatal Medicine, Chelsea & Westminster Hospital, London, UK
  1. Correspondence to Dr I M Balfour-Lynn, Department of Paediatric Respiratory Medicine, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK; i.balfourlynn{at}


Background During air flight, cabin pressurisation produces an effective fraction of inspired oxygen (FiO2) of 0.15. This can cause hypoxia in predisposed individuals, including infants with bronchopulmonary dysplasia (BPD), but the effect on ex-preterm babies without BPD was uncertain. The consequences of feeding a baby during the hypoxia challenge were also unknown.

Methods Ex-preterm (without BPD) and term infants had fitness to fly tests (including a period of feeding) at 3 or 6 months corrected gestational age (CGA) in a body plethysmograph with an FiO2 of 0.15 for 20 min. A ‘failed’ test was defined as oxygen saturation (SpO2) <90% for at least 2 min.

Results 41 term and 30 ex-preterm babies (mean gestational age 39.8 and 33.1 weeks, respectively) exhibited a significant median drop in SpO2 (median −6%, p<0.0001); there was no difference between term versus ex-preterm babies, or 3 versus 6 months. Two term (5%) and two ex-preterm (7%) babies failed the challenge. The SpO2 dropped further during feeding (median −4% in term and −2% in ex-preterm, p<0.0001), with transient desaturation (up to 30 s) <90% seen in 8/36 (22%) term and 9/28 (32%) ex-preterm infants; the ex-preterm babies desaturated more quickly (median 1 vs 3 min, p=0.002).

Conclusions Ex-preterm babies without BPD and who are at least 3 months CGA do not appear to be a particularly at-risk group for air travel, and routine preflight testing is not indicated. Feeding babies in an FiO2 of 0.15 leads to a further fall in SpO2, which is significant but transient.

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  • Correction notice This article has been corrected since it was published Online First. The authors have requested that AH be added as the fourth author to this paper.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Brompton, Harefield & National Heart Lung Institute Research Ethics Committee South Eastern Sydney and Illawarrah Human Research Ethics Committee – Northern Hospital Network Sector.

  • Provenance and peer review Not commissioned; externally peer reviewed.