Adaptive control of inspired oxygen delivery to the neonate

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Abstract
Adaptive adjustment of inspired oxygen (Fio2), based on a desired percent arterial hemoglobin saturation (S02) was achieved by on‐line bedside control of the oxygen concentration delivered to the neonate. Fourteen infants with bronchopulmonary dysplasia (BW, 860 ± 80 g; GA, 26 ± 1 weeks; study age, 41 ± 8 days) receiving oxygen‐air mixtures by hood were studied. The desired range of S, from 92 to 96% with a target value of 95% was determined by pulse oximetry and maintained with adjustment of Fio2 using three modes: (1) standard neonatal intensive care protocol with oxygen delivery evaluated at 20 minute intervals; (2) bedside manual control with Fio2 manipulation every 2 to 5 minutes; and (3) adaptive control with on‐line adjustment of Fio2 according to a specifically designed adaptive program. Each study period was of 40 minute duration. So2, values within a steady 94 to 96% range was achieved for 54010 of the time with standard protocol, compared to 69% (P < 0.01) with bedside manual control and 81% (P < 0.01) with adaptive control. In addition, fluctuations in So2, values and overshoots were less apparent with adaptive control of oxygen delivery. These data describe adaptive Fio2, control as an efficient alternative technique for achieving a stable desired range of oxygenation in neonates.