Automated ventilation systems in neonatology

In 2023, more than 4,000 children were born extremely prematurely in Germany alone, i.e., before the end of the 28th week of pregnancy. They need additional oxygen via respiratory support systems because their immature lungs are not yet able to supply the body with sufficient gas. "The administration of oxygen is the most common measure for this patient group," says Prof. Dr. Andreas Flemmer, Head of Neonatology at LMU Klinikum München Großhadern and Hauner Children's Hospital: "Nevertheless, we know very little about the optimal dose." Too little means undersupply; too much oxygen damages the lungs and the retina of the eyes, even leading to retinal detachment, which can cause blindness. Pop legend Stevie Wonder, for example, experienced this 75 years ago.

Manual readjustment as a daily challenge

To optimize effectiveness and minimize the risk of side effects, oxygen supply should be precisely dosed within a narrow target range, depending on the oxygen saturation in the children's blood. However, infants often breathe very irregularly, and the ventilation and function of their lungs also fluctuate. This means that nursing staff must constantly readjust the concentration of oxygen supplied by hand, which is a challenge given the limited staff resources available. Can machines with automated digital technology take over the adjustment of oxygen supply and reduce both the rate of lung problems in children and the rate of retinal complications?

Large-scale study involving over 1,000 premature babies

To find out, more than 30 clinics in Germany and around the world launched a study that was funded by the German Research Foundation, independent of any manufacturer. More than 1,000 infants born between the 23rd and 27th weeks of pregnancy took part. They were divided into two groups. In group 1, oxygen supply was regulated automatically. The premature babies in group 2 received the previous routine treatment with manual adjustment of oxygen.
"Overall, across all participants," says Andreas Flemmer, "we did not see any statistically significant effect" – neither less lung damage nor fewer serious retinal problems nor fewer children dying from complications related to their premature birth.

Ein Gerät sticht heraus: 35 Prozent weniger Lungenkomplikationen

Enlarge

However, the participating clinics used three different ventilators. According to Flemmer, individual analysis of the various machines showed “that the ventilator used in our wards significantly reduced the rate of dangerous lung complications by 35 percent.” This considerable effect will most likely lead to further development of the algorithms used in other devices.

Conclusion: Relief for nursing staff

The evaluation of the overall study also showed that automatic oxygen regulation has no adverse effects on the young patients. As the Munich-based neonatologist says, this means that "this technology can be used, which greatly reduces the workload for nursing staff in everyday clinical practice because they no longer have to manually readjust the oxygen supply every time an alarm sounds. The machine now does that.“ Overall, Andreas Flemmer sums up, ”it's a worthwhile study that changes practice."