Preliminary study of automated oxygen titration at birth for preterm infants

Before-after trial of using automated oxygen control in the delivery room, showing similar results as with manual control (70 vs. 60%) for %time in target, and significantly less time spent in potential hyperoxaemia. Objective To study the feasibility of automated titration of oxygen therapy in the delivery room for preterm infants. Design Prospective non-randomised study of oxygenation in sequential preterm cohorts in which FiO(2) was adjusted manually or by an automated control algorithm during the first 10 min of life. Setting Delivery rooms of a tertiary level hospital. Participants Preterm infants <32 weeks gestation (n=20 per group). Intervention Automated oxygen control using a purpose-built device, with SpO(2) readings input to a proportional-integral-derivative algorithm, and FiO(2) 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 SpO(2) target was the 25th-75th centile of the Dawson nomogram. Main outcome measures Proportion of time in the SpO(2) target range (25th-75th centile, or above if in room air) and other SpO(2) ranges; FiO(2) adjustment frequency; oxygen exposure. Results Time in the SpO(2) target range was similar between groups (manual control: median 60% (IQR 48%-72%); automated control: 70 (60-84)%; p=0.31), whereas time with SpO(2) >75th centile when receiving oxygen differed (manual: 17 (7.6-26)%; automated: 10 (4.4-13)%; p=0.048). Algorithm-directed FiO(2) adjustments were frequent during automated control, but no manual adjustments were required in any infant once valid SpO(2) values were available. Oxygen exposure was greater during automated control, but final FiO(2) was equivalent. Conclusion Automated oxygen titration using a purpose-built algorithm is feasible for delivery room management of preterm infants, and warrants further evaluation.