***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: In preterm infants receiving supplemental oxygen  , manual control of the inspired oxygen fraction is often time-consuming and inappropriate . We developed a system for automatic oxygen control and hypothesized that this system is more effective than routine manual oxygen control in maintaining target arterial oxygen saturation levels . We performed a r and omized controlled crossover clinical trial in 12 preterm infants receiving nasal continuous positive airway pressure and supplemental oxygen .  Periods with automatic and routine manual oxygen control were compared with periods of optimal control by a fully dedicated person . The median ( range ) percentage of time with arterial oxygen saturation levels within target range ( 87 - 96 % ) was 81.7 % ( 39.0 - 99.8 ) for routine manual oxygen control , 91.0 % ( 41.4 - 99.3 ) for optimal control , and 90.5 % ( 59.0 - 99.4 ) for automatic control ( ANOVA : p = 0.01 ) . Pairwise post hoc comparisons revealed a statistically significant difference between automatic and routine manual oxygen control ( Dunnett 's test : p = 0.02 ) . The frequency of manual oxygen adjustments was lowest in automatic control ( Friedman 's test : p < 0.001 ) . Automatic oxygen control may optimize oxygen administration to preterm infants receiving nasal continuous positive airway pressure and reduce nursing time spent with oxygen control Objective : To determine if a change in the pulse oximeter goal range and high alarm limit for  oxygen saturation  ( SpO2 ) alters the distribution of SpO2 for premature infants in oxygen . Study design : This was a prospect i ve , observational analysis . For group 1 ( February 2002 to April 2002 , n=23 ) , pulse oximeter alarms were set at 80 % ( low ) and 96 % ( high ) , and the goal range was 90–95 % . For group 2 ( May 2002 to August 2003 , n=49 ) , the high alarm was lowered to 94 % , and the goal range was 88 to 94 % . The SpO2 values for 24 h were downloaded from Nellcor pulse oximeters during the two periods and the percent time within , above and below the goal range was derived and compared . Results : Groups were similar except for use of post-natal steroids ( group 2>1 ) . The percent time within ( 57.7±9.8 vs 59.4±12.4 % ) , above ( 15.4±10.6 vs 14±9.4 % ) and below ( 26.9±9.7 vs 26.6±10.2 % ) the goal range was similar for groups 1 and 2 , respectively . However , the percent time with SpO2 < 80 % increased significantly for group 2 ( 4.0±2.7 vs 1.9±1.4 % ) . Conclusions : Changes in pulse oximeter policy and alarms in labile , sick premature infants need evaluation for their effects on the distribution of SpO2 values before routine use OBJECTIVE . The objective of this study was to determine the rate of compliance with hospital guidelines for alarm limits for pulse oximetry in preterm infants on oxygen therapy . METHODS . All infants admitted to the nurseries at the Royal Women 's Hospital , Melbourne , Australia , with gestational age < 32 weeks or birth weight < 1500 g between August 2005 and February 2006 were eligible for inclusion . Data on the alarm limits set for infants on oxygen therapy were collected prospect ively . The target saturation range recommended in written hospital guidelines was 88 % to 92 % , with alarm limits set at 85 % and 94 % . RESULTS . Data were prospect ively collected for 144 subjects with mean ( SD ) gestational age 29.3 ( 2.4 ) weeks and birth weight 1226 ( 354 ) g ; 1073 alarm limits were collected when infants were on oxygen . The lower alarm limit was set correctly 91.1 % of the time . In contrast , the upper alarm limit was set correctly only 23.3 % of the time : 76.5 % of the time it was too high , and 23.8 % of the time it was set at 100 % . Infants with an upper alarm limit set correctly on a particular day had a significantly lower birth weight , gestational age , postmenstrual age , and postnatal age than infants who had the upper alarm limit set too high . Use of assisted ventilation , higher inspired oxygen concentrations , and more frequent changes in inspired oxygen concentration were all associated with improved odds of having an appropriately set upper alarm limit . CONCLUSIONS . This study suggests that current guidelines regarding the upper pulse oximeter alarm limit for infants receiving oxygen might be commonly exceeded , although compliance might be better for infants at higher risk of adverse outcomes . However , there might be less variation from guidelines for the lower alarm limit OBJECTIVE To better underst and the impact of hypoxia and hyperoxia on  neonatal morbidity and mortality , we examined the number of  hypoxia and hyperoxia events as well as percentage of time spent outside oxygen saturation targets in relationship to threshold retinopathy of prematurity ( tROP ) and mortality in preterm infants . STUDY DESIGN Saturation data in 2-second sampling from pulse oximeters was prospect ively collected in a single NICU .  Average SaO2 , low and high saturation events , duration of events , and percentage of time infants spent outside of oxygen saturation range were collected and analyzed continuously during the hospitalization . RESULTS 102 infants < 1500 g or < 32 weeks gestation were enrolled . There were 125 , 112 , and 43 hypoxia events/day and 106 , 80 , and 34 hyperoxia events/day for tROP ( N=8 ) , non-survivor ( N=16 ) and non-tROP patients ( N=78 ) , respectively . Infants were outside saturation targets for 2:35 , 1:38 , and 1:03 ( hypoxia ) and 2:02 , 1:25 , and 0:38 hours/day ( hyperoxia ) for tROP , non-survivor and non-tROP , respectively . Time spent outside saturation range ( hypoxia , hyperoxia and total time ) for the hospital course was higher in tROP ( P≤0.006 ) and non-survivor ( P≤0.005 ) compared with non-tROP patients . The three groups defined themselves in the first 10 days after birth , with regard to duration of hypoxia ( P=0.0003 ) , hyperoxia ( P=0.0004 ) and total time outside the targeted saturation range ( P=0.0006 ) . CONCLUSIONS Information such as the duration and number of hypoxia and hyperoxia events , as well as total time outside the targeted saturation range , could be factored into assessing clinical interventions and research studies in the prevention , treatment and evaluation of neonatal outcomes BACKGROUND AND OBJECTIVE : In preterm infants receiving supplemental oxygen  , routine manual control ( RMC ) of the fraction of inspired oxygen ( FIO2 ) is often difficult and time consuming . We developed a system for closed-loop automatic control ( CLAC ) of the FIO2 and demonstrated its short-term safety and efficacy in a single-center study . The objective of this study was to test the hypothesis that this system is more effective than RMC alone in maintaining arterial oxygen saturation within target levels when evaluated over 24 hours under routine conditions and with different target levels . METHODS : We performed a multicenter , r and omized controlled , crossover clinical trial in 34 preterm infants receiving mechanical ventilation or nasal continuous positive airway pressure and supplemental oxygen .  Twenty-four – hour periods with RMC were compared with 24-hour periods of RMC supported by CLAC . RESULTS : The median ( range ) percentage of time with arterial oxygen saturation levels within target range was 61.4 ( 31.5–99.5 ) for RMC and 71.2 ( 44.0–95.4 ) for CLAC ( P < .001 ) . The median ( range ) number of manual FIO2 adjustments was reduced from 77.0 ( 0.0–224.0 ) for RMC to 52.0 ( 10.0–317.0 ) for CLAC ( P = .007 ) . CONCLUSIONS : CLAC may improve oxygen administration to preterm infants receiving mechanical ventilation or nasal continuous positive airway pressure while reducing workload related to RMC BACKGROUND Previous studies have suggested that the incidence of retinopathy is lower in preterm infants with exposure to reduced levels of oxygenation than in those exposed to higher levels of oxygenation . However , it is unclear what range of oxygen saturation is appropriate to minimize retinopathy without increasing adverse outcomes . METHODS We performed a r and omized trial with a 2-by-2 factorial design to compare target ranges of oxygen saturation of 85 to 89 % or 91 to 95 % among 1316 infants who were born between 24 weeks 0 days and 27 weeks 6 days of gestation . The primary outcome was a composite of severe retinopathy of prematurity ( defined as the presence of threshold retinopathy , the need for surgical ophthalmologic intervention , or the use of bevacizumab ) , death before discharge from the hospital , or both . All infants were also r and omly assigned to continuous positive airway pressure or intubation and surfactant . RESULTS The rates of severe retinopathy or death did not differ significantly between the lower-oxygen-saturation group and the higher-oxygen-saturation group ( 28.3 % and 32.1 % , respectively ; relative risk with lower oxygen saturation , 0.90 ; 95 % confidence interval [ CI ] , 0.76 to 1.06 ; P=0.21 ) . Death before discharge occurred more frequently in the lower-oxygen-saturation group ( in 19.9 % of infants vs. 16.2 % ; relative risk , 1.27 ; 95 % CI , 1.01 to 1.60 ; P=0.04 ) , whereas severe retinopathy among survivors occurred less often in this group ( 8.6 % vs. 17.9 % ; relative risk , 0.52 ; 95 % CI , 0.37 to 0.73 ; P<0.001 ) . There were no significant differences in the rates of other adverse events . CONCLUSIONS A lower target range of oxygenation ( 85 to 89 % ) , as compared with a higher range ( 91 to 95 % ) , did not significantly decrease the composite outcome of severe retinopathy or death , but it result ed in an increase in mortality and a substantial decrease in severe retinopathy among survivors . The increase in mortality is a major concern , since a lower target range of oxygen saturation is increasingly being advocated to prevent retinopathy of prematurity . ( Clinical Trials.gov number , NCT00233324 . OBJECTIVE To determine if participation in a r and omised controlled trial of different oxygen saturation targets improved compliance with oximeter alarm limit guidelines . DESIGN Eligible infants were born after the commencement of the BOOST II trial . Data on alarm limits were collected on all infants < 32 weeks ' gestational age or birth weight < 1500 g , who were born at The Royal Women 's Hospital , Melbourne between February and June 2007 , and receiving supplemental oxygen at the time of the audit . The proportions of infants in oxygen  with correct alarm limits ( upper 94 % ; lower 85 % or 86 % ) were compared , between those in the BOOST II trial and those who were not , and with an earlier audit . RESULTS Of 100 infants surveyed , 56 had received  oxygen  ( mean gestational age at birth 26.7 weeks , mean birth weight 913 g ) . Compliance with lower limits was good in both periods , irrespective of post-menstrual age or participation in the trial . Compliance with upper limits improved after trial commencement , but only for infants enrolled in the trial and only whilst they were < 36 weeks ' post-menstrual age . CONCLUSIONS Starting a clinical trial of oxygen targeting was associated with improved compliance with upper alarm limits for participants receiving supplemental oxygen , but only whilst they were < 36 weeks ; with little effect outside the trial OBJECTIVE To assess the efficacy of a system for automated fraction of inspired oxygen ( FiO(2 ) ) adjustment in maintaining oxygen saturation ( SpO(2 ) ) within an intended range in preterm infants with spontaneous fluctuations in SpO(2 ) . STUDY DESIGN Sixteen infants ( gestational age , 24.9 + /- 1.4 weeks ; birth weight , 678 + /- 144 g ; age , 33 + /- 15 days ) with frequent hypoxemia episodes underwent two 4-hour periods of FiO(2 ) adjustment by clinical personnel ( routine ) and the automated system ( automated ) . RESULTS Compared with the routine period , the percent time within intended SpO(2 ) range ( 88%-95 % ) increased during the automated period ( 58 % + /- 10 % versus 42 % + /- 9 % ; P < .001 ) , whereas the percent time with SpO(2 ) higher than the intended range and > or=98 % were reduced ( 9 % + /- 10 % versus 31 % + /- 8 % [ P < .001 ] and 3 % + /- 5 % versus 16 % + /-  
    Output:
    
The main finding is that there is a low compliance in oxygen targeting ; the upper alarm limits are inappropriately set , and maintaining the saturation ( SpO2 ) below the upper limit presented particular difficulties .
Although there is little data available , the studies indicate that training , titration protocol s and decreasing workload could improve awareness and compliance .
Automated oxygen regulations have been shown to increase the time that SpO2 is within the target range .
Conclusion : The compliance in targeting oxygen during oxygen therapy in preterm infants is low , especially in maintaining the SpO2 below the upper limit .
What is Known:• The use of oxygen in preterm infants is vital , but the optimal strategy remains controversial.• Targeting SpO2during oxygen therapy in preterm infants has been shown to reduce mortality and morbidity .
What is New:• Review of the literature showed that the compliance in targeting SpO2 and alarm setting s is low.• Creating awareness of risks of oxygen therapy and benefits in targeting , decreasing nurse/patient ratio and automated oxygen therapy could increase compliance