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Editorial
Automated oxygen control in the preterm infant: automation yes, but we need intelligence
  1. Peter Anderson Dargaville1,2,
  2. Axel Franz3,
  3. Christian F Poets3,
  4. Timothy J Gale4
  1. 1 Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia
  2. 2 Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
  3. 3 Department of Neonatology, University of Tuebingen, Tuebingen, Germany
  4. 4 School of Engineering and ICT, University of Tasmania, Hobart, Tasmania, Australia
  1. Correspondence to Dr Peter Anderson Dargaville, Department of Paediatrics, Royal Hobart Hospital, Hobart, Australia; peter.dargaville{at}dhhs.tas.gov.au

https://doi.org/10.1136/archdischild-2018-316371

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    Artificial intelligence (AI), the mimicry of human intelligence with computer systems, has found its way into so many fields of human endeavour and is finding its way into ours.1 Already well entrenched in several healthcare disciplines, there would appear to be great potential for AI and lesser forms of automation in neonatology and neonatal intensive care, and examples already exist in the areas of clinical decision support (eg, risk prediction from large and/or complex datasets2) and machine-oriented repetitive operations (eg, tidal volume targeting3 and temperature control4). To this latter list can also be added automated control of inspired oxygen concentration in preterm infants, numerous algorithms for which have been developed over the years, with a number of them now incorporated in contemporary neonatal ventilators and studied in preclinical5 or clinical6–10 settings. Common findings are that these devices afford a greater proportion of time with oxygen saturation (SpO2) in the target range, with less time in the extremes of hypoxaemia and hyperoxaemia.

    Seemingly against this tide of technological advance, the evolution of respiratory care in preterm infants in recent decades has seen the persistence/resurgence of one ‘low-tech’ form of mechanical respiratory support, continuous positive airway pressure (CPAP) and the emergence of another, nasal high flow (HF).11 Within a few years, enthusiasm for nasal HF has burgeoned, and it has been used in increasing numbers of preterm infants, at a variety of stages of their journey through the neonatal intensive care unit (NICU). Many aspects of the nasal HF package are attractive; it is simple and easy to use, induces less nasal trauma and can be widely applied, including in low-resource settings.

    Given the potential value of automated oxygen control for preterm infants, and the increasing uptake of nasal HF, it makes sense to link the …

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    Footnotes

    • Contributors PAD wrote the first draft of the manuscript and assembled contributions from AF, CFP and TJG. All authors approved the final version.

    • Competing interests The University of Tasmania and Royal Hobart Hospital have jointly lodged a provisional patent application concerning automated control of inspired oxygen concentration in the newborn infant and have a licencing agreement with SLE Limited in relation to OxyGenie automated oxygen control software. The University of Tuebingen holds a patent on the CLAC algorithm for automated oxygen control and have a licencing agreement with Löwenstein Medical in relation to this algorithm. AF and CFP are supported by a grant of the German Ministry of Research and Education for conducting the FiO2-C study on medium-term effects of closed-loop automated control of FiO2. No other competing interests are declared.

    • Provenance and peer review Commissioned; internally peer reviewed.

    • Patient consent for publication Not required.

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