Predictive Intelligent Control of Oxygenation in Preterm Infants: A Two-Center Feasibility Study

Abstract

<b><i>Introduction:</i></b> Supplemental oxygen therapy is a mainstay of modern neonatal intensive care for preterm infants. However, both insufficient and excess oxygen delivery are associated with adverse outcomes. Automated or closed loop FiO₂ control has been developed to keep SpO2 within a predefined target range more effectively. <b><i>Methods:</i></b> The aim of this study was to investigate the feasibility of closed loop FiO₂ control by Predictive Intelligent Control of Oxygenation (PRICO) on the Fabian ventilator in maintaining SpO2 within a target range (88/89-95%) in preterm infants on different modes of invasive and noninvasive respiratory support. In two tertiary neonatal intensive care units, preterm infants with an FiO₂ &#x3e;0.21 were included and received an 8 h nonblinded treatment period of closed loop FiO₂ control by PRICO, flanked by two 8 h control periods of routine manual control (RMC1 and RMC2). <b><i>Results:</i></b> 32 preterm infants were included (median gestational age 26 + 5 weeks [IQR 25 + 5–27 + 6], median birthweight 828 grams [IQR 704–930]). Six patients received invasive respiratory support, while 26 received noninvasive respiratory support (18 CPAP, 4 DuoPAP, and 4 nasal IMV). The time percentage within the SpO2 target range was increased with PRICO (74.4% [IQR 67.8–78.5]) compared to RMC1 (65.8% [IQR 51.1–77.8]; <i>p</i> = 0.011) and RMC2 (60.6% [IQR 56.2–66.6]; <i>p</i> &#x3c; 0.001) with an estimated median difference of 6.0% (95% CI 1.2–11.5) and 9.8% (95% CI 6.0–13.0), respectively. <b><i>Conclusion:</i></b> In preterm infants on invasive and noninvasive respiratory supports, closed loop FiO₂ control by PRICO compared to RMC is feasible and superior in maintaining SpO2 within target ranges.