Control of breathing in preterm infants on incubator oxygen or nasal cannula oxygen

Colm P Travers; Rouba Chahine; Arie Nakhmani; Inmaculada Aban; Waldemar A Carlo; Namasivayam Ambalavanan

doi:10.1038/s41390-024-03460-5

Control of breathing in preterm infants on incubator oxygen or nasal cannula oxygen

Pediatr Res. 2024 Aug 15. doi: 10.1038/s41390-024-03460-5. Online ahead of print.

Authors

Colm P Travers¹, Rouba Chahine^{2

3}, Arie Nakhmani⁴, Inmaculada Aban³, Waldemar A Carlo⁵, Namasivayam Ambalavanan⁵

Affiliations

¹ Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA. cptravers@uabmc.edu.
² Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC, USA.
³ Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴ Department of Electrical and Computer Engineering, University of Alabama at Birmingham, Birmingham, AL, USA.
⁵ Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.

PMID: 39147903
DOI: 10.1038/s41390-024-03460-5

Abstract

Background: Incubator oxygen may improve respiratory stability in preterm infants compared with nasal cannula oxygen.

Methods: Single center randomized trial of infants <29 weeks' gestation on supplemental oxygen at ≥32 weeks' postmenstrual age. Infants were crossed-over every 24 hours for 96 hours between incubator oxygen and nasal cannula ≤1.0 L/kg/min. We measured episodes of intermittent hypoxemia (oxygen saturations (SpO₂) < 85% ≥10 seconds), bradycardia, cerebral and abdominal hypoxemia, and end-tidal carbon dioxide.

Results: We enrolled 25 infants with a gestational age of 26 weeks 4 days±15 days (mean ± SD) and birth weight 805 ± 202 grams. There were no differences in episodes of intermittent hypoxemia, bradycardia, or cerebral hypoxemia between groups. There were fewer episodes of abdominal hypoxemia <40% ≥10 seconds with incubator oxygen compared with nasal cannula (132 ± 130 versus 158 ± 125; p < 0.01). Time with SpO₂ < 85% and abdominal hypoxemia was lower among infants on incubator oxygen. Carbon dioxide values were higher while on incubator oxygen (41 ± 11 versus 36 ± 10 mmHg; p < 0.02).

Conclusion: There was no difference in intermittent hypoxemia between incubator and nasal cannula oxygen among preterm infants on supplemental oxygen. Infants had higher levels of carbon dioxide while on incubator oxygen, which may have improved some measures of respiratory stability. CLINCALTRIALS.

Gov identifiers: NCT03333174 and NCT03174301.

Impact statement: In this randomized cross-over trial of preterm infants on supplemental oxygen, incubator oxygen did not decrease episodes of intermittent hypoxemia compared with nasal cannula oxygen. Incubator oxygen reduced time with oxygen saturations less than 85%, reduced abdominal hypoxemia, and increased carbon dioxide levels. Differences in measures of respiratory stability on incubator oxygen may be partly due to higher carbon dioxide levels compared with nasal cannula oxygen. The mode of supplemental oxygen administration may impact control of breathing in preterm infants through its effect on hypopharyngeal oxygen stability and carbon dioxide levels.

Associated data

ClinicalTrials.gov/NCT03333174
ClinicalTrials.gov/NCT03174301