Hyperoxia and hypoxia influence morbidity and mortality of preterm infants. Automated closed-loop control of the fraction of inspired oxygen (FiO2) has been shown to facilitate oxygen supplementation in the neonatal intensive care unit (NICU), but has not yet been tested during preterm resuscitation. We hypothesized that fully automated FiO2 control based on predefined oxygen saturation (SpO2) targets was applicable in both preterm resuscitation and ventilation.Methods:Twenty-two preterm lambs were operatively delivered and intubated in a modified EXIT procedure. They were randomized to receive standardized resuscitation with either automated or manual FiO2 control, targeting SpO2 according to the Dawson curve in the first 10 min and SpO2 90-95% hereafter. Automated FiO2 control also was applied during surfactant replacement therapy and subsequent ventilation.Results:Time within target range did not differ significantly between manual and automated FiO2 control during resuscitation, however automated FiO2 control significantly avoided hyperoxia. Automated FiO2 control was feasible during surfactant replacement and kept SpO2 within target range significantly better than manual control during subsequent ventilation.Conclusion:In our model, fully automated FiO2 control was feasible in rapidly changing physiologic conditions during postnatal resuscitation and prevented hyperoxia. We conclude that closed loop FiO2 control is a promising tool for the delivery room.

dx.doi.org/10.1038/pr.2015.158, hdl.handle.net/1765/91429
Pediatric Research: international journal of human developmental biology

Hutten, M.C, Goos, T.G, Ophelders, D.R.M.G, Nikiforou, M, Kuypers, E, Willems, M, … Kramer, B.W. (2015). Fully automated predictive intelligent control of oxygenation (PRICO) in resuscitation and ventilation of preterm lambs. Pediatric Research: international journal of human developmental biology, 78(6), 657–663. doi:10.1038/pr.2015.158