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In the trials that contributed to the Neonatal Oxygen Prospective Meta-analysis, extremely preterm infants were randomised to be cared for with higher (SpO₂ 91-95%) or lower (SpO₂ 85-89%) pulse oximeter saturation targets. The trials showed, without heterogeneity, that infants randomised to lower SpO₂ targets had increased risk of death and of severe necrotising enterocolitis and decreased risk of requiring treatment for retinopathy of prematurity. The oximeters were masked, so the caregivers were not aware which randomisation group the baby was in and the risk of bias due to differences in practice between randomisation groups other than in adjustment of inspired oxygen should be minimal. It is therefore likely that the differences in outcome between groups are explained by differences in achieved oxygen saturation distribution. Exploration of the achieved oxygen saturation patterns in the trials and the patterns associated with adverse outcomes can inform current practice and generate hypotheses to be tested in the next generation of oxygenation trials.

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Background and aim: Physiological-based cord clamping (PBCC) is suggested to obtain stable cardiac output and heart rate (HR) during neonatal transition. This may also result in a better cerebral tissue oxygenation and perfusion.
To evaluate differences in HR, arterial oxygen saturation (SpO2), cerebral tissue oxygen saturation (cTOI), and cerebral blood volume (CBV) during neonatal transition in healthy term infants receiving either PBCC or early cord clamping (ECC).

Methods: A randomized controlled trial (clinicaltrials.gov: NCT02763436) including vaginally delivered healthy term infants. Within the first 15 minutes after birth continuous measurement of HR and SpO2 using pulse oximetry and cTOI and CBV using near-infrared spectroscopy were performed. Values of the PBCC group (CC after succeeded aeration of the lungs) were compared to those of the ECC group (CC within the first 60 seconds after birth).

Results: A total of 71 term infants (PBCC n=35; ECC n=36) with mean gestational age of 40.0 weeks (SD±7days) and birth weight of 3479 (SD±424) grams were included. Time of CC was median 275 (IQR: 197 - 345) seconds in the PBCC group and 58 (IQR: 35 - 86) seconds in the ECC group (p<0.001). Between the two groups there were no significant differences in HR (p=0.878), SpO2 (p=0.322), cTOI (p=0.319) and ∆CBV (p =0.814) during neonatal transition detectable.

Conclusion: There were no significant differences in HR, SpO2, cTOI and CBV detectable during the first 15 minutes after birth in vaginally delivered healthy term infants, who received either early cord clamping or physiological-based cord clamping.

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Background:

Automated control of inspired oxygen (FiO₂) improves oxygen saturation (SpO₂) targeting in preterm infants, but performance during periods of clinical care remains undocumented.

Methods:

In a 24 h crossover study in 35 infants, FiO₂ was adjusted manually or automatically (VDL1.1 algorithm). Periods of clinical care ≥1 min, flanked by ≥10 min free from patient interaction, were identified. SpO₂ targeting was quantified and compared on a per-infant basis between care and non-care periods for each control mode, and between control modes.

Results:

Birth gestation was 27 (26-28) weeks [median (IQR)] and post-natal age 17 (11-23) days. SpO₂ targeting was worse during care periods for both automated and manual FiO₂ control (Table). There were, however, far fewer manual FiO₂ adjustments ≥2% during automated control (median 0 (0-1) vs 6 (3.5-13) per care period, P<0.01).

Conclusions:

Automated oxygen control was less effective during care periods than at other times, affording SpO₂ targeting equivalent to that seen during manual oxygen control, but with far fewer manual FiO₂ adjustments.