Closed-Loop Automated Oxygen Control in Preterm Infants Receiving Non-Invasive Respiratory Support

Background/Objectives: Closed-loop automated oxygen control (CLAC) systems improve compliance with oxygen saturation targets and other outcomes in preterm ventilated infants. This narrative review aimed to explore the efficacy of CLAC systems in preterm infants receiving non-invasive respiratory support and identify areas that needed further research. Methods: A literature search was conducted using PubMed. The search terms were 'closed loop' or 'automat*', 'oxygen' and 'neonat*'. Results: Sixteen studies were identified: twelve randomised crossover studies, three randomised controlled trials (RCTs) and a matched-cohort study. Nine studies included only infants receiving non-invasive respiratory support, and the remaining seven incorporated results from infants either on invasive or non-invasive ventilation. Overall, CLAC was associated with an increased percentage of time spent within the target oxygen saturation range and reduced time spent in extremes of oxygenation (SpO₂ < 80% and SpO₂ > 98%) when compared with manual oxygen control. CLAC was applied in infants receiving different modes of non-invasive respiratory support, including continuous positive airway pressure, high and low-flow nasal cannula oxygen. Some of the studies had limited power as they were prematurely stopped due to recruitment or equipment issues. Study periods were mostly less than or equal to 24 h. There were no data on longer-term clinical outcomes, including bronchopulmonary dysplasia, retinopathy of prematurity, necrotising enterocolitis and mortality. Conclusions: CLAC improves the achievement of oxygen saturation targets in preterm infants receiving non-invasive respiratory support. Future research is needed to explore the effect of CLAC on clinical outcomes in this population.