Preliminary study of automated oxygen titration at birth for preterm infants

To study the feasibility of automated titration of oxygen therapy in the delivery room for preterm infants.

Prospective non-randomised study of oxygenation in sequential preterm cohorts in which FiO₂ was adjusted manually or by an automated control algorithm during the first 10 min of life.

Delivery rooms of a tertiary level hospital.

Preterm infants <32 weeks gestation (n=20 per group).

Automated oxygen control using a purpose-built device, with SpO₂ readings input to a proportional-integral-derivative algorithm, and FiO₂ alterations actuated by a motorised blender. The algorithm was developed via in silico simulation using abstracted oxygenation data from the manual control group. For both groups, the SpO₂ target was the 25th-75th centile of the Dawson nomogram.

Proportion of time in the SpO₂ target range (25th-75th centile, or above if in room air) and other SpO₂ ranges; FiO₂ adjustment frequency; oxygen exposure.

Time in the SpO₂ target range was similar between groups (manual control: median 60% (IQR 48%-72%); automated control: 70 (60-84)%; p=0.31), whereas time with SpO₂ >75th centile when receiving oxygen differed (manual: 17 (7.6-26)%; automated: 10 (4.4-13)%; p=0.048). Algorithm-directed FiO₂ adjustments were frequent during automated control, but no manual adjustments were required in any infant once valid SpO₂ values were available. Oxygen exposure was greater during automated control, but final FiO₂ was equivalent.

Automated oxygen titration using a purpose-built algorithm is feasible for delivery room management of preterm infants, and warrants further evaluation.