Hylke Salverda

Abstract Faster resolution of hypoxaemic or hyperoxaemic events in preterm infants may reduce long-term neurodevelopmental impairment. Automatic titration of inspiratory oxygen increases time within the oxygen saturation target range and may provide a more prompt response to hypoxic and hyperoxic events. We assessed routinely performed follow-up at two years of age after implementation of automated oxygen control (AOC) as standard care and compared this with a historical cohort. Neurodevelopmental outcomes at two years of age were compared for infants born at 24-29 weeks gestational age before (2012-2015) and after (2015-2018) implementation of AOC as standard of care. Primary outcome was a composite outcome of either mortality or severe neurodevelopmental impairment (NDI), other outcomes assessed were mild-moderate NDI, Bayley-III composite scores, cerebral palsy GMFCS and CBCL problem behaviour scores. 289 infants were eligible in the pre-AOC epoch and 292 in the post-AOC epoch. Baseline characteristics were not significantly different. 51 infants were lost to follow-up (pre-AOC 6.9% (20/289), postimplementation 10.6% (31/292)). The composite outcome of mortality or severe NDI was observed in 17.9% pre-AOC (41/229) vs. 24.0% (47/196) post-AOC (p=0.12). No significant differences were found for the secondary outcomes such as mildmoderate NDI, Bayley-III composite scores, cerebral palsy GMFCS and problem behaviour scores, with the exception of parent-reported readmissions until moment of follow-up which was less frequent post-AOC than pre-AOC. Conclusion In this cohort study, implementation of automated oxygen control in our NICU as standard of care for preterm infants led to no statistically significant difference in neurodevelopmental outcome at two years of age. Keywords: Hypoxemia; hyperoxia; closed-loop; algorithm; neonate; respiratory; follow-up