Neonatal automated oxygen titration algorithms: response characteristics and performance
Archives of Disease in Childhood Fetal & Neonatal, pp. fetalneonatal–2026
Abstract
Objective Neonatal respiratory support devices now have algorithms for automated adjustment of oxygen concentration (fraction of inspired oxygen (FiO 2 )) in response to oxygen saturation (SpO 2 ) disturbances, but their performance has not been systematically examined. We investigated the response of six available devices and algorithms to standardised and simulated SpO 2 disturbances. Design Bench-top study in neonatal centres. Methods Devices under study received SpO 2 input from a vital signs simulator at 1 Hz; device response was recorded as measured FiO 2 in the respiratory circuit. Response to protracted hypoxaemia (SpO 2 =80%) and hyperoxaemia (SpO 2 =98%) was examined in several test conditions. In closed-loop testing, measured FiO 2 was combined with abstracted patient data in an oxygenation simulator, generating novel SpO 2 values input to the device. Device capability in keeping simulated SpO 2 in target range (91–95%) was examined, as was FiO 2 adjustment frequency and propensity for FiO 2 oscillation. Results The FiO 2 trajectories in response to SpO 2 disturbances differed considerably between devices. Maximum rate of sustained FiO 2 escalation (ΔFiO 2 /min) during hypoxaemia was Avea: 0.30; Fabian: 0.20; Leoni: 0.20; SLE: 0.10; Sophie: 0.062; Vapotherm: 0.30. Corresponding values for FiO 2 reduction during hyperoxaemia were 1.20, 0.20, 0.20, 0.13, 0.53 and 1.32. In closed-loop testing, average SpO 2 target range time proportion was 51%, 52%, 55%, 77%, 64% and 53% for the six devices, respectively, with 1.9–5.1 automated FiO 2 adjustments/min, in some cases with a prominent oscillatory pattern. Conclusions Automated oxygen control devices exhibit considerable variation in their FiO 2 response to SpO 2 disturbances, with important consequences for SpO 2 targeting potential and the pattern of FiO 2 adjustment.
Authors 13
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University of Tasmania · Leiden University Medical Center · Willem-Alexander Kinderziekenhuis · Menzies Institute for Medical Research
Affiliation as printed
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
Paediatrics, Division of Neonatology, Leids Universitair Medisch Centrum Willem Alexander Kinderziekenhuis, Leiden, The Netherlands
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Heidelberg University · University Hospital Heidelberg · Universitätsklinikum Tübingen
Affiliation as printed
Neonatology, University Hospital Heidelberg Center of Paediatric and Adolescent Medicine, Heidelberg, BW, Germany
Neonatology, University Hospital Tübingen, Tübingen, BW, Germany
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University of Tasmania · Menzies Institute for Medical Research
Affiliation as printed
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
School of Engineering, University of Tasmania, Hobart, Tasmania, Australia
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University of Tasmania · Menzies Institute for Medical Research
Affiliation as printed
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
School of Engineering, University of Tasmania, Hobart, Tasmania, Australia
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Affiliation as printed
School of Engineering, University of Tasmania, Hobart, Tasmania, Australia
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Affiliation as printed
Neonatology, University Hospital Tübingen, Tübingen, BW, Germany
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Affiliation as printed
Pediatrics, Division of Neonatology, University of Miami Leonard M Miller School of Medicine, Miami, Florida, USA
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Erasmus MC · Erasmus MC - Sophia Children’s Hospital · Delft University of Technology
Affiliation as printed
Biomechanical Engineering, Delft University of Technology Faculty of Mechanical Maritime and Materials Engineering, Delft, The Netherlands
Neonatal and Paediatric Intensive Care, Erasmus MC Sophia, Rotterdam, ZH, Netherlands
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Affiliation as printed
Pediatrics, Ulm University, Ulm, Germany
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University of Bristol · University of Oxford
Affiliation as printed
University of Bristol Faculty of Health Sciences, Bristol, UK
University of Oxford National Perinatal Epidemiology Unit, Oxford, UK
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Poznan University of Medical Sciences
Affiliation as printed
II Department of Neonatology, Uniwersytet Medyczny imienia Karola Marcinkowskiego w Poznaniu, Poznan, Wielkopolskie, Poland
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Leiden University Medical Center · Willem-Alexander Kinderziekenhuis
Affiliation as printed
Paediatrics, Division of Neonatology, Leids Universitair Medisch Centrum Willem Alexander Kinderziekenhuis, Leiden, The Netherlands
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University of Tasmania · Royal Hobart Hospital · Menzies Institute for Medical Research
Affiliation as printed
Department of Pediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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