Environmental or Nasal Cannula Supplemental Oxygen for Preterm Infants: A Randomized Cross-Over Trial.

Academic Article


  • OBJECTIVE: To test the hypothesis that environmental compared with nasal cannula oxygen decreases episodes of intermittent hypoxemia (oxygen saturations <85% for ≥10 seconds) in preterm infants on supplemental oxygen by providing a more stable hypopharyngeal oxygen concentration. STUDY DESIGN: This was a single center randomized crossover trial with a 1:1 parallel allocation to order of testing. Preterm infants on supplemental oxygen via oxygen environment maintained by a servo-controlled system or nasal cannula with flow rates ≤1.0 L per kg per minute were crossed over every 24 hours for 96 hours. Data were collected electronically to capture real time numeric and waveform data from patient monitors. RESULTS: Twenty-five infants with gestational age of 27 ± 2 weeks (mean ± SD) and a birth weight of 933 ± 328 g were studied at postnatal day 36 ± 26. The number of episodes of intermittent hypoxemia per 24 hours was 117 ± 77 (median, 98; range, 4-335) with oxygen environment vs 130 ± 63 (median, 136; range, 16-252) with nasal cannula (P = .002). Infants on oxygen environment compared with nasal cannula also had decreased episodes of severe intermittent hypoxemia (P = .005). Infants on oxygen environment compared with nasal cannula had a lower proportion of time with oxygen saturations <85% (.05 ± .03 vs .06 ± .03, P < .001), and a lower coefficient of variation of oxygen saturation (P = .02). CONCLUSIONS: In preterm infants receiving supplemental oxygen, servo-controlled oxygen environment decreases hypoxemia compared with nasal cannula. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02794662.
  • Published In


  • bronchopulmonary dysplasia, incubator, infant, intermittent hypoxemia, neonatal, neonate, newborn, respiratory distress syndrome, servo-controlled, supplemental, Cannula, Continuous Positive Airway Pressure, Cross-Over Studies, Equipment Design, Female, Gestational Age, Humans, Hypoxia, Infant, Newborn, Infant, Premature, Male, Nose, Oxygen Inhalation Therapy
  • Digital Object Identifier (doi)

    Author List

  • Travers CP; Carlo WA; Nakhmani A; Bhatia S; Gentle SJ; Amperayani VA; Indic P; Aban I; Ambalavanan N
  • Start Page

  • 98
  • End Page

  • 103
  • Volume

  • 200