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Clinical outcomes of preterm infants while using automated controllers during standard care: comparison of cohorts with different automated titration strategies
  1. Hylke H Salverda1,
  2. Dianthe M L Beelen1,
  3. Sophie J E Cramer2,
  4. Steffen C Pauws1,3,
  5. Nicoline Schalij-Delfos4,
  6. Arjan B te Pas2
  1. 1Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Neonatology, Leiden University Medical Center, Leiden, The Netherlands
  3. 3Tilburg center for Cognition and Communication, Tilburg University, Tilburg, The Netherlands
  4. 4Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Dr Hylke H Salverda, Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands; H.H.Salverda{at}lumc.nl

Abstract

Objective To compare short-term clinical outcome after using two different automated oxygen controllers (OxyGenie and CLiO2).

Design Propensity score-matched retrospective observational study.

Setting Tertiary-level neonatal unit in the Netherlands.

Patients Preterm infants (OxyGenie n=121, CLiO2 n=121) born between 24+0–29+6 weeks of gestation. Median (IQR) gestational age in the OxyGenie cohort was 28+3 (26+3.5–29+0) vs 27+5 (26+5–28+3) in the CLiO2 cohort, respectively 42% and 46% of infants were male and mean (SD) birth weight was 1034 (266) g vs 1022 (242) g.

Interventions Inspired oxygen was titrated by OxyGenie (SLE6000) or CLiO2 (AVEA) during respiratory support.

Main outcome measures Mortality, retinopathy of prematurity (ROP), bronchopulmonary dysplasia and necrotising enterocolitis.

Results Fewer infants in the OxyGenie group received laser coagulation for ROP (1 infant vs 10; risk ratio 0.1 (95% CI 0.0 to 0.7); p=0.008), and infants stayed shorter in the neonatal intensive care unit (NICU) (28 (95% CI 15 to 42) vs 40 (95% CI 25 to 61) days; median difference 13.5 days (95% CI 8.5 to 19.5); p<0.001). Infants in the OxyGenie group had fewer days on continuous positive airway pressure (8.4 (95% CI 4.8 to 19.8) days vs 16.7 (95% CI 6.3 to 31.1); p<0.001) and a significantly shorter days on invasive ventilation (0 (95% CI 0 to 4.2) days vs 2.1 (95% CI 0 to 8.4); p=0.012). There were no statistically significant differences in all other morbidities.

Conclusions In this propensity score-matched retrospective study, the OxyGenie epoch was associated with less morbidity when compared with the CLiO2 epoch. There were significantly fewer infants that received treatment for ROP, received less intensive respiratory support and, although there were more supplemental oxygen days, the duration of stay in the NICU was shorter. A larger study will have to replicate these findings.

  • respiratory
  • intensive care units, neonatal
  • ophthalmology
  • neonatology

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors HHS: co-conceived the study (with ATP) conducted the study, compiled, analysed and interpreted the data (with SCP), co-wrote the first draft of the manuscript and approved the final version of the manuscript. DLMB: collected and analysed data, reviewed and edited the manuscript and approved the final version of the manuscript. SJEC: reviewed and edited the manuscript, and approved the final version of the manuscript. SCP: reviewed and edited the manuscript, performed the analysis and interpretation of the data and approved the final version of the manuscript. NS-D: interpreted and performed eye examinations, reviewed and edited the manuscript and approved the final version of the manuscript. ABtP: is guarantor of the study, co-conceived the study, oversaw the study conduct, interpreted the data, co-wrote the first draft of the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests ABtP has received an unrestricted research grant from SLE; they had no role in study design nor in the collection, analysis and interpretation of data, writing of the report and decision to submit the paper for publication.

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