Hypoxic events and concomitant factors in preterm infants on non-invasive ventilation

Automated control of inspired oxygen for newborn infants is an emerging technology, currently limited by reliance on a single input signal (oxygen saturation, SpO 2 ). This is while other signals that may herald the onset of hypoxic events or identify spurious hypoxia are not usually utilised. We wished to assess the frequency of apnoea, loss of circuit pressure and/or motion artefact in proximity to hypoxic events in preterm infants on non-invasive ventilation. Hypoxic events (SpO 2 15 s) preceding hypoxic events, were associated with a relatively slow decline in SpO 2 and more prolonged hypoxia compared to shorter pauses. Hypoxic events are frequently accompanied by respiratory pauses and/or motion artefact. Real-time monitoring and input of respiratory waveform may thus improve the function of automated oxygen controllers, allowing pre-emptive responses to respiratory pauses. Furthermore, use of motion-resistant oximeters and plethysmographic waveform assessment procedures will help to optimise feedback control of inspired oxygen delivery.