TOPLINE:

In premature infants receiving mechanical ventilation, automated oxygen control was associated with shorter durations of mechanical ventilation and supplemental oxygen, a lower incidence of bronchopulmonary dysplasia, and a lower need for home oxygen at discharge than manual oxygen control.

METHODOLOGY:

• In a randomised controlled trial conducted between September 2021 and March 2025 at a tertiary neonatal unit in London, UK, researchers compared the duration of mechanical ventilation between premature infants who underwent ventilation with closed-loop automated oxygen control (CLAC) and those who underwent ventilation with manual oxygen control.
• They included 69 infants born at less than 34 weeks of gestation (median gestational age, 27 weeks; median birth weight, 795 g).
• The infants were randomly assigned to receive either CLAC (n = 34) or manual oxygen control (n = 35) within 48 hours of starting mechanical ventilation and remained in their allocated group until successful extubation.
• The primary outcome was the duration of mechanical ventilation.
• Secondary outcomes were the percentage of time spent within the target oxygen saturation range (SpO₂, 91%-95%), the time spent in hypoxaemia (SpO₂ < 85%) or hyperoxaemia (SpO₂ > 95%), the length of neonatal unit stay, the number of days on supplemental oxygen, the incidence of bronchopulmonary dysplasia at a postmenstrual age of 36 weeks, and the need for home oxygen.

TAKEAWAY:

• Infants receiving CLAC showed shorter durations of mechanical ventilation (median, 11 vs 40 days; P = .027) and supplemental oxygen (median, 33 vs 47 days; P = .031) than those receiving manual control.
• The percentage of time spent within the target SpO₂ range was significantly higher and the time spent in hyperoxaemia and hypoxaemia was significantly lower with automated control than with manual control (P < .001 for all).
• Infants in the automated control group had a lower incidence of bronchopulmonary dysplasia (55% vs 83.9%; P = .015) and a lower need for home oxygen at discharge (26.5% vs 51.4%; P = .016) than those in the manual control group.
• The median length of neonatal unit stay was not significantly different between the two groups.

IN PRACTICE:

"In our study, CLAC was associated with a significantly reduced time spent below the target oxygen range (SpO₂ < 91%) and the time spent in hypoxaemia (SpO₂ < 85%) over a period of 28 days," the authors wrote.

SOURCE:

This study was led by Ourania Kaltsogianni, Faculty of Life Sciences and Medicine, King's College London, London, England. It was published online on November 10, 2025, in Archives of Disease in Childhood - Fetal and Neonatal Edition.

LIMITATIONS:

This was a single-centre study with a relatively small sample size, so larger multicentre trials are needed to confirm the findings. The performance of automated oxygen controllers may have varied, and demographic imbalances between the two groups could have introduced confounding factors.

DISCLOSURES:

This study did not receive any funding. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.