Neonatal Intensive Care

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An overview of the pathophysiological features of HIE showing stages and etiologies of brain injury. @newborn @newborn

🫁 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) 📌 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. ⚠️ 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. 📚 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. @newborn @newborn