EVALUATION OF CEREBRAL HYPOXEMIA IN EXTREMELY PRETERM INFANTS EARLY IN RESPIRATORY SUPPORT: EFFECTS OF AUTOMATED ADJUSTMENT OF INSPIRED OXYGENATION
DOI:
https://doi.org/10.14311/CTJ.2025.1.05Abstract
In this pilot study we aimed to evaluate the effectiveness of automated FiO2 adjustment (A-FiO2) in reducing the risk of cerebral tissue hypoxemia in the first weeks of life, when compensatory mechanisms that favor cerebral oxygenation are less developed. Randomized cross-over study switching between two consecutive 24-hour periods of A-FiO2 and manual FiO2 control. Extremely preterm infants requiring respiratory support, without significant patent ductus arteriosus were randomized in the first week of life. Masimo neonatal peripheral pulse oximeter and 5100C NIRS oximeter were used to continuously measure SpO2 and crStO2. The AVEA-CLiO ventilator was used during both automated and manual FiO2 adjustment periods. The primary endpoint was the burden of hypoxemia calculated as the area under the two hypoxemia thresholds. Thirteen preterm infants were enrolled, with a gestational age of 26.8 ± 0.8 weeks, a birth weight of 907 ± 247 grams, an age at intervention of 7.1 ± 1.3 days, FiO2 of 0.33 ± 0.10, and receiving respiratory support consisting of mechanical ventilation in one infant, nasal intermittent positive pressure ventilation in six infants, and nasal continuous positive airway pressure in six infants. The average FiO2, SpO2 and crStO2 were similar during the study. Measures of hypoxemia favored A-FiO2, including a significantly lower burden of peripheral hypoxemia (%SpO2-hours: 3.0 ± 2.0 vs. 8.0 ± 6.1, p=0.010) and a lower burden of cerebral hypoxemia (%crStO2-hours: 8.9 ± 20 vs. 20 ± 30, p=0.008)]. In this group of very young extremely preterm infants we confirmed that A-FiO2 resulted in reduced peripheral hypoxemia. Moreover, we showed that the improvement in SpO2 control resulted in reduced exposure to low crStO2. Larger studies would be needed to determine the magnitude of the improvement and its clinical relevance.
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Copyright (c) 2026 Ilaria Stucchi, Francesco Cavigioli, Francesca Castoldi, Sara Gatto, Paola A La Verde, Petrina Bastrenta, Massimo Bellettato, Stefania Vedovato, Thomas E Bachman, Gianluca Lista
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