Clinical outcomes of preterm infants while using automated controllers during standard care: comparison of cohorts with different automated titration strategies

Abstract

ObjectiveTo compare short-term clinical outcome after using two different automated oxygen controllers (OxyGenie and CLiO2).DesignPropensity score-matched retrospective observational study.SettingTertiary-level neonatal unit in the Netherlands.PatientsPreterm infants (OxyGenie n=121, CLiO2n=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 CLiO2cohort, respectively 42% and 46% of infants were male and mean (SD) birth weight was 1034 (266) g vs 1022 (242) g.InterventionsInspired oxygen was titrated by OxyGenie (SLE6000) or CLiO2(AVEA) during respiratory support.Main outcome measuresMortality, retinopathy of prematurity (ROP), bronchopulmonary dysplasia and necrotising enterocolitis.ResultsFewer 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.ConclusionsIn this propensity score-matched retrospective study, the OxyGenie epoch was associated with less morbidity when compared with the CLiO2epoch. 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.