Automation of oxygen titration in preterm infants: Current evidence and future challenges

Statistical Description of SaO2–SpO2 Relationship for Model of Oxygenation in Premature Infants

“…This work and further improvements of the complex mathematical model will enhance the in silico testing and comparison of existing and future control algorithms under real clinical conditions. There is a need for improved modeling that reflects the dynamics of the neonatal oxygen transport system to achieve optimal control across the full spectrum of oxygenation disturbances, including the possibility of individualization of algorithm performance [10].…”

“…In the last ten years, many articles have introduced closed-loop control algorithms of oxygenation in neonates, but a complex clinical study to compare the effectiveness of those various algorithms is still missing [6]. Clinical tests of the new oxygenation control algorithms of neonates bring safety and ethical risks, but a mathematical model of oxygenation in neonates can allow for the in silico simulation of oxygenation and preliminary comparison of the control algorithms [7][8][9][10].…”

Survey of closed‐loop automated oxygen control systems in neonatal intensive care units

“…Newborn infants with respiratory disease frequently require supplemental oxygen, but its delivery must be carefully titrated to avoid the harmful effects of hypoxia and hyperoxia. 1 Manual adjustment of the inspired oxygen concentration (FiO 2 ) is known to be associated with a considerable proportion of time spent outside the target oxygen saturation (SpO 2 ) range. 2 Closed-loop automated oxygen control (CLAC) delivery systems have emerged as a potential solution and have been shown to be advantageous in crossover studies, with an increased percentage of time spent within the target SpO 2 range and fewer manual FiO 2 adjustments 3-5 in infants on non-invasive respiratory support or mechanically ventilated across a arrange of postnatal ages.…”

Automated Oxygen Delivery in Neonatal Intensive Care

“…Oxygen is a drug with a narrow therapeutic range in vulnerable preterm neonates. Avoiding both hypoxemia and hyperoxemia is important especially in neonates as both are associated with short-term and long-term adverse outcomes (1,2). Hypoxemia causes cellular damage, and this may be associated with poor outcomes such as death or disability (3)(4)(5).…”

“…Studies using A-FiO2 have consistently shown to improve the proportion of time spent in the TR of SpO2, reduce hypoxemia and hyperoxemia in preterm infants on non-invasive or invasive respiratory support. Whilst the A-FiO2 systems have been commercially available, it has not yet established itself in the routine care in the neonatal ICU ( 2 , 13 ). This is indicative of the challenges with its use, and more importantly the lack of clinical outcome data with the use of A-FiO2.…”