PS-278 Automated Versus Manual Fio2 Control At Different Saturation Targets In Preterm Infants

Background Preterm infants spend only 50% of time within the target oxygen saturation (SpO2) during manual FiO2 control (M-FiO2). Automated FiO2 control (A-FiO2) improves SpO2 targeting but it is uncertain if this applies to different SpO2 target ranges and during non-invasive support (NIVS) and mechanical ventilation (MV). Objective To compare the efficacy of A-FiO2 vs M-FiO2 in keeping two different SpO2 targets during NIVS or MV. Design/methods Preterm infants on FiO2 >0.21 receiving NIVS or MV were randomised to SpO2 targets 89–93% or 91–95% and underwent M-FiO2 and A-FiO2 for 24 h each, in random sequence. Results 80 infants (GA:26 w, age:18 d) were included (NIVS = 48, MV = 32). Time within target increased and below target decreased during A-FiO2 compared with M-FiO2, especially in the lower target range. There was a reduction in time and hypoxemia episodes with SpO2 target 21 (13) 25 (10)* 22 (13) 19 (8) %-time 98% 0.2 (0.0–0.8) 0.7 (0.1–1.6)* 0.7 (0.2–2.1) 1.7 (0.7–4.3) %-time SpO2 1 min/24 h 4 (1–12) 15 (5–24)* 4 (1–11) 13 (3–24)* Manual FiO2 adjustments/24h 1 (0–3) 102 (72–173)* 1 (0–3) 109 (79–156)* * p < 0.0

Congenital diaphragmatic hernia: current status and review of the literature.

Treatment of congenital diaphragmatic hernia (CDH) challenges obstetricians, pediatric surgeons, and neonatologists. Persistent pulmonary hypertension (PPHT) associated with lung hypoplasia in CDH leads to a high mortality rate at birth. PPHT is principally due to an increased muscularization of the arterioles. Management of CDH has been greatly improved by the introduction of prenatal surgical intervention with tracheal obstruction (TO) and by more appropriate postnatal care. TO appears to accelerate fetal lung growth and to increase the number of capillary vessels and alveoli. Improvement of postnatal care over the last years is mainly due to the avoidance of lung injury by applying low peak inflation pressure during ventilation. The benefits of other drugs or technical improvements such as the use of inhaled nitric oxide or extracorporeal membrane oxygenation (ECMO) are still being debated and no single strategy is accepted worldwide. Despite intensive clinical and experimental research, the treatment of newborn with CDH remains difficult