Automated oxygen control in preterm infants: a new frontier in neonatal respiratory care. A review

Gustavo Rocha, Department of Neonatology, Centro Hospitalar Universitário de São João, ULS São João, Porto, Portugal

Maintaining optimal oxygen saturation (SpO2) in preterm infants remains a critical yet challenging aspect of neonatal intensive care. Manual adjustment of inspired oxygen (FiO2) is both labor-intensive and prone to human error, often resulting in significant fluctuations in oxygen levels that may increase the risk of complications such as retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), and long-term neurodevelopmental impairment. Emerging evidence indicates that automated oxygen control (AOC) systems enhance the stability of SpO2, reduce the frequency of hypoxic and hyperoxic episodes, and minimize the need for manual FiO2 adjustments. Despite these promising physiological improvements, high-certainty evidence demonstrating a positive impact on short- and long-term clinical outcomes remains lacking. Current data on mortality, severe ROP, BPD, and neurodevelopmental outcomes are limited and often of low certainty. AOC technology shows significant potential to improve oxygen management in preterm infants by maintaining target saturation ranges more consistently. However, robust, high-quality multicenter trials are essential to confirm its clinical benefits, assess its feasibility in various healthcare settings, and assess cost-effectiveness. This review synthesizes the current evidence surrounding the use of AOC in preterm infants, with a focus on its efficacy, safety profile, and potential role in advancing neonatal respiratory care.

Keywords: Automated oxygen control. Hyperoxia. Hypoxia. Neonatal intensive care. Oxygen saturation. Preterm infants.