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The effect of implementing an automated oxygen control on oxygen saturation in preterm infants
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  • Published on:
    Implementation of an automated oxygen Control system- Are we ready?
    • Jogender Kumar, Neonatologist Post Graduate Institute of Medical education and Research, Chandigarh India 160012
    • Other Contributors:
      • Sankalp Dudeja, Neonatologist
      • Pradeep Debata, Neonatologist
      • Khurana Supreet, Neonatologist
      • Abhishek Aradhya, Neonatologist
      • Venkataseshan Sundaram, Neonatologist

    We read with great interest the article by Van Zanten HA et al., published in this journal and found the results impressive.[1] However, we have certain observations about the conduct of the study
    Even though the authors state that this report was part of a quality improvement initiative in their NICU, the authors have neither reported the results in the format suitable for a quality improvement study nor have clearly stated the design; at the end of introduction they seem to mention that this was a retrospective data analysis; whereas, in the first line of the methods they state the design as a prospective observational study. Even though the automatic oxygen controller group would not have been affected much by any one of the design, the impact would have been in the manual group, keeping especially the training of the NICU staff in mind. It’s also worth emphasizing here that the authors mention about the local guidelines practiced for manual titration of supplemental oxygen based on the saturations, for the sake of external validity.[2]
    Minute wise data points used in this study may have significantly underestimated the hypoxemic episodes and thereby the proportion of times an infant remained in the ‘below target range’ saturations. In a logical sense, manual titration would have happened sooner than expected for a hypoxemic event and hence would not have been captured if more frequent data points are not considered. Using the same technology and a lesser in...

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    Conflict of Interest:
    None declared.
  • Published on:
    Implementation of an automated oxygen Control system- Are we ready?
    • Jogender Kumar, Neonatologist Post Graduate Institute of Medical education and Research, Chandigarh India 160012
    • Other Contributors:
      • Sankalp Dudeja, Neonatologist
      • Venkatseshan Sundaram, Associate Professor Pediatrics (Neonatology)

    We read with great interest the article by Van Zanten HA et al., published in this journal and found it very useful.1 The author rightly stated that the results reflect the real situation as data were collected for the duration infants were admitted, while nurses taking care of them and where workload varied. It will be very relevant for developing countries where nurse patient ratio is poor. But; at the same time would like to offer following comments, clarification to which would benefit the readers of this journal and will help in replication of these results in different settings also.
    It is not very clear whether it was a prospective study or retrospective. In Introduction section, in the end, the author mentioned that we performed a retrospective study in preterm infants to evaluate automated fraction of inspired oxygen (FiO2) control when it was used as standard care and thus for a longer period. While in “Methods” section it is mentioned that it was a prospective observational study. These contradictory statements create confusion to the reader.
    The author mentioned that during the manual period, the nurses manually titrated the supplemental oxygen following local guidelines. However; these guidelines are not given in the current paper. It would be better if clear guidelines would have been described like other studies to improve the external validity and generalizability.2
    In the present study, FiO2 and pulse oximeter saturation (SpO2) were sa...

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    Conflict of Interest:
    None declared.