An observational study to quantify manual adjustments of the inspired oxygen fraction in extremely low birth weight infants

Aim: To quantify manual fraction of inspired oxygen (FiO2) adjustments performed by caregivers in extremely low birth weight (ELBW; =1000 g) infants, in relation to oxygen saturation (SpO2) and bedside care. Methods: In a single-centre study, FiO(2), SpO(2) and alarm limits of ELBW infants were collected for 3 days continuously, while caregivers were filmed. A descriptive analysis, focused on manual FiO(2) adjustments, was performed. Results: Twelve ELWB infants were included. Total recording time was 726 h. FiO2 was increased 851 times and decreased 1309 times; median (range) step size was 5% (1% to 65%) and) 3% () 1% to) 65%), respectively. Wide variation of FiO(2) adjustments for equal levels of SpO2 was observed in all included infants. One hundred and twenty-six of 136 FiO(2) adjustments with a step size 15% and 111 of 171 desaturations <70% were associated with medical or nursing procedures. When FiO(2) was >21%, alarm Conclusions: Manual FiO(2) adjustments varied widely in frequency and step size. Deep desaturations and large FiO(2) adjustments were associated with medical or nursing procedures. When large adjustments are really necessary, it will be challenging to implement them in an automatic adjustment device.