Introduction: The Challenge of Oxygen Titration in the NICU
Managing supplemental oxygen for extremely preterm infants (born before 28 weeks of gestation) is one of the most delicate tasks in neonatal intensive care. These infants are highly susceptible to the dual risks of hypoxia and hyperoxia. Frequent hypoxemic episodes are associated with an increased risk of mortality and neurodevelopmental impairment, while excessive oxygen exposure (hyperoxia) is a primary driver of oxidative stress, leading to complications such as retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD).
Traditionally, clinicians and bedside nurses manually adjust the fractional concentration of inspired oxygen (FiO2) based on pulse oximetry (SpO2) readings. However, maintaining SpO2 within a narrow target range is notoriously difficult due to the physiological instability of preterm infants and the high workload of bedside caregivers. Closed-loop automated control of FiO2 (FiO2-C) was developed to address this challenge. Previous physiological studies have consistently shown that FiO2-C increases the percentage of time infants spend within the target SpO2 range and reduces the workload of nursing staff. However, whether these physiological improvements translate into better clinical outcomes remained an unanswered question until the publication of the FiO2-C trial.
