Hylke Salverda

29 2 Automated oxygen control in preterm infants, how does it work and what to expect Introduction Preterm infants often receive respiratory support, including supplemental oxygen therapy for a prolonged period of time during their first hospitalisation. Provision of supplemental oxygen must aim to keep oxygen saturation within a normoxic range, thereby minimising occurrence of hypoxia and hyperoxia, both of which are associated with organ injury.1-6 But titrating oxygen therapy manually within the narrow therapeutic range is a difficult task to perform.7, 8 Over the last four decades, a number of algorithms have been developed to facilitate automatic titration of oxygen for preterm infants. All the contemporary algorithms use oxygen saturation as measured by pulse oximetry (SpO2) as their input, but each has a different design in processing the input and computing an adjustment in the fraction of inspired oxygen (FiO2). An important prerequisite to successfully applying automated oxygen control (AOC) in clinical practice will be for clinicians to understand how the control algorithms operate and what effect differences in design have.9-21 Six oxygen control algorithms are currently embedded in commercially available neonatal ventilators. This narrative review will consider the different approaches to algorithm design, explain how the contemporary algorithms operate and, based on available data, discuss their clinical effects in preterm infants. For this, we performed a search on PubMed, Embase, Web of Science, Cochrane and Emcare for (pre)clinical studies and reviews comparing AOC with manual titration of oxygen in preterm infants receiving respiratory support and oxygen therapy. A cross-check for search completeness was made using the reference list of primary resources, aiming to identify any studies not located in the initial search. Additionally, patent documents and device operating manuals were studied where available.