Objective Neonatal respiratory support devices now have algorithms for automated adjustment of oxygen concentration (fraction of inspired oxygen (FiO2)) in response to oxygen saturation (SpO2) disturbances, but their performance has not been systematically examined. We investigated the response of six available devices and algorithms to standardised and simulated SpO2 disturbances.Design Bench-top study in neonatal centres.Methods Devices under study received SpO2 input from a vital signs simulator at 1 Hz; device response was recorded as measured FiO2 in the respiratory circuit. Response to protracted hypoxaemia (SpO2=80%) and hyperoxaemia (SpO2=98%) was examined in several test conditions. In closed-loop testing, measured FiO2 was combined with abstracted patient data in an oxygenation simulator, generating novel SpO2 values input to the device. Device capability in keeping simulated SpO2 in target range (91-95%) was examined, as was FiO2 adjustment frequency and propensity for FiO2 oscillation.Results The FiO2 trajectories in response to SpO2 disturbances differed considerably between devices. Maximum rate of sustained FiO2 escalation (Delta FiO2/min) during hypoxaemia was Avea: 0.30; Fabian: 0.20; Leoni: 0.20; SLE: 0.10; Sophie: 0.062; Vapotherm: 0.30. Corresponding values for FiO2 reduction during hyperoxaemia were 1.20, 0.20, 0.20, 0.13, 0.53 and 1.32. In closed-loop testing, average SpO2 target range time proportion was 51%, 52%, 55%, 77%, 64% and 53% for the six devices, respectively, with 1.9-5.1 automated FiO2 adjustments/min, in some cases with a prominent oscillatory pattern.Conclusions Automated oxygen control devices exhibit considerable variation in their FiO2 response to SpO2 disturbances, with important consequences for SpO2 targeting potential and the pattern of FiO2 adjustment.
Introduction Preterm birth includes four subgroups: extremely (<28 weeks' gestation), very (28(+0)-31(+6)), moderate (32(+0)-33(+6), MPT) and late (34(+0)-36(+6), LPT). While school attainment is well-studied across subgroups, other aspects of daily life are rarely reported for MPT, LPT and early term (37(+0)-38(+6), ET) or are explored only qualitatively. Objective Assess daily life, including school and quality of life at age 10 years for MPT, LPT and ET compared with full-term (39(+0)-40(+6), FT) peers. Methods Children born in 2011 from two birth cohorts (ELFE: >= 33(+0) weeks; EPIPAGE-2: <= 34(+6) weeks) completed a 10-year follow-up via telephone interview (n=8373) and home visit (n=6418). Weighting addressed selection bias. Outcome-wide regressions (modified Poisson, linear) were used to calculate adjusted relative risks (aRR) and beta-coefficients (beta). Results MPT had a higher risk of receiving any school support (aRR 1.67, 95% CI 1.10 to 2.54). Their risk for difficulties in French and mathematics was, respectively, 1.32 (95% CI 1.01 to 1.74) and 1.50 (95% CI 1.13 to 1.99) times higher, while school-related quality of life was 0.30 (95% CI -0.58 to -0.02) SD lower relative to FT. They were 2.02 times more likely to be non-swimmers (95% CI 1.24 to 3.29). Both MPT/LPT were less likely to eat school meals but reported higher overall well-being scores (+0.16 SD and +0.13 SD, respectively). The study sample may under-represent socioeconomically deprived groups. Conclusions MPT/LPT children's daily lives differ from those of FT children in some respects. Those discrepancies should be explored further to better understand needs and accommodate them. Findings may not generalise to disadvantaged groups.
