🫁
Can a ventilator adjust oxygen by itself?
One of the major challenges in caring for extremely preterm infants is maintaining
SpO₂ within the target range.
Both
hypoxemia and hyperoxemia can be harmful. Therefore, NICU clinicians continuously adjust the FiO₂ according to changes in the infant’s oxygen saturation.
But what if the machine could do this automatically?
🔬
What does the latest evidence show?
A large multicenter randomized controlled trial published in
The Lancet Child & Adolescent Health evaluated
automatic versus manual oxygen control in extremely preterm infants.
The study included more than
1,000 infants born at 23–27+6 weeks of gestation across 32 NICUs.
In the intervention group, a
closed-loop automated FiO₂ control system continuously used SpO₂ data to adjust the oxygen concentration.
Interestingly, the primary clinical outcome was
not significantly different:
🔹 Death, NEC, BPD, or severe ROP:
39% with automated oxygen control
vs.
41% with manual control
There was also no significant difference in the individual outcomes of:
• Mortality
• Necrotizing enterocolitis (NEC)
• Bronchopulmonary dysplasia (BPD)
• Severe retinopathy of prematurity (ROP)
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So, does automated oxygen control not work?
Not necessarily.
Previous studies have shown that closed-loop systems can increase the amount of time infants spend within the target SpO₂ range and may reduce episodes of both hypoxemia and hyperoxemia.
They may also reduce the workload associated with frequent manual FiO₂ adjustments.
However, the 2026 trial suggests that
better oxygen targeting does not automatically translate into better major clinical outcomes.
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Clinical message
Automated FiO₂ control should
not be considered a replacement for clinical judgment.
The technology may become an important tool for reducing oxygen fluctuations and supporting bedside clinicians, but careful monitoring and appropriate clinical decision-making remain essential.
🔑
The future of neonatal oxygen therapy may not be
Human vs. machine
but rather:
Human + intelligent technology.
The goal is not simply to achieve a target SpO₂ value, but to minimize the dangerous swings between
hypoxemia and hyperoxemia.
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Reference
Franz AR, Maiwald CA, Niemarkt HJ, et al. Automatic versus manual control of oxygen and neonatal clinical outcomes in extremely preterm infants: a multicentre, parallel-group, randomised, controlled, superiority trial.
Lancet Child Adolesc Health. 2026;10(3):179–188. doi:10.1016/S2352-4642(25)00351-7.
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