***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 Background It is possible that cross-over studies included in current systematic review s are being inadequately assessed , because the current risk of bias tools do not consider possible biases specific to cross-over design . We performed this study to evaluate whether this was being done in  cross-over studies included in Cochrane  Systematic Review s ( CSRs ) . Methods We search ed the Cochrane Library ( up to 2013 issue 5 ) for CSRs that included at least one cross-over trial . Two authors independently undertook the study selection and data extraction . A r and om sample of the CSRs was selected and we evaluated whether the cross-over trials in these CSRs were assessed according to criteria suggested by the Cochrane h and book . In addition we reassessed the risk of bias of these cross-over trials by a checklist developed form the Cochrane h and book . Results We identified 688 CSRs that included one or more cross-over studies . We chose a r and om sample of 60 CSRs and these included 139 cross-over studies . None of these CSRs undertook a risk of bias assessment specific for cross-over studies . In fact items specific for cross-over studies were seldom considered anywhere in quality assessment of these CSRs . When we reassessed the risk of bias , including the 3 items specific to cross-over trials , of these 139 studies , a low risk of bias was judged for appropriate cross-over design in 110(79 % ) , carry-over effects in 48(34 % ) and for reporting data in all stages of the trial in 114(82 % ) . Assessment of biases in cross-over trials could affect the GRADE assessment of a review ’s findings . Conclusion The current Cochrane risk of bias tool is not adequate to assess cross-over studies . Items specific to cross-over trials leading to potential risk of bias are generally neglected in CSRs . A proposed check list for the evaluation of cross-over trials is provided OBJECTIVE To assess the effect of automated adjustment of the inspired oxygen fraction ( FiO2 ) on arterial oxygen saturation ( SpO2 ) and cerebral tissue oxygen saturation ( SctO2 ) in very low birth weight infants with frequent fluctuations in oxygenation . STUDY DESIGN Fifteen infants ( median gestational age , 25 weeks [ range , 23 - 28 weeks ] ; median age , 34 days [ range , 19 - 74 days ] ) were assigned in r and om sequence to 24 hours of automated adjustment of FiO2 or manual adjustment of FiO2 . Primary outcome measurements were time within the SpO2 target range and the area under the curve above and below a defined SctO2 range . RESULTS Percentage of time within the SpO2 target range increased during automated FiO2 control ( 76.3 % ± 9.2 % vs 69.1 % ± 8.2 % for manual ; P < .01 ) . Prolonged episodes with SpO2 < 88 % of > 60 seconds duration ( median , 115 episodes [ range , 67 - 240 ] vs 54 episodes [ range , 7 - 184 ] ; P < .01 ) and of > 180 seconds duration ( median , 13 episodes [ range , 6 - 39 ] vs 2 episodes [ range , 0 - 5 ] ; P < .01 ) decreased significantly during the automated period . Percentage of time with SpO2 > 96 % decreased during automated control ( 6.6 % ± 4.4 % vs 10.4 % ± 3.3 % ; P < .02 ) . There was no significant difference in FiO2 exposure . The area ( deviation × time ) below and above the defined SctO2 threshold did not differ between the 2 periods ( median , 59.7%*seconds [ range , 17.2%-208.3 % ] for manual vs 49.0%*seconds [ range , 4.3%-193.7 % ] for automated ; P = .36 ) . CONCLUSION Automated FiO2 control in preterm infants with frequent SpO2 fluctuations significantly increased the time within the SpO2 target range and reduced the incidence of prolonged hypoxemic events compared with manual FiO2 adjustment , but did not significantly affect cerebral tissue oxygenation 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 OBJECTIVE To determine the efficacy and safety of automated adjustment of the fraction of inspired oxygen ( FiO2 ) in maintaining arterial oxygen saturation ( SpO2 ) within a higher ( 91%-95 % ) and a lower ( 89%-93 % ) target range in preterm infants . STUDY DESIGN Eighty preterm infants ( gestational age [ median ] : 26 weeks , age [ median ] 18 days ) on noninvasive ( n = 50 ) and invasive ( n = 30 ) respiratory support with supplemental oxygen  , were first r and omized to one of the SpO2 target ranges and then treated with automated FiO2 ( A-FiO2 ) and manual FiO2 ( M-FiO2 ) oxygen control for 24 hours each , in r and om sequence . RESULTS The percent time within the target range was higher during A-FiO2 compared with M-FiO2 control . This effect was more pronounced in the lower SpO2 target range ( 62 ± 17 % vs 54 ± 16 % , P < .001 ) than in the higher SpO2 target range ( 62 ± 17 % vs 58 ± 15 % , P < .001 ) . The percent time spent below the target or in hypoxemia ( SpO2 < 80 % ) was consistently reduced during A-FiO2 , independent of the target range . The time spent above the target range or at extreme hyperoxemia ( SpO2 > 98 % ) was only reduced during A-FiO2 when targeting the lower SpO2 range ( 89%-93 % ) . These outcomes did not differ between infants on noninvasive and invasive respiratory support . Manual adjustments were significantly reduced during A-FiO2 control . CONCLUSIONS A-FiO2 control improved SpO2 targeting across different SpO2 ranges and reduced hypoxemia in preterm infants on noninvasive and invasive respiratory support . TRIAL REGISTRATION IS RCT N 56626482 Objective To evaluate the performance of a novel rapidly responsive proportional-integral-derivative ( PID ) algorithm for automated oxygen control in preterm infants with respiratory insufficiency . Design Interventional study of a 4-hour period of automated oxygen control compared with combined data from two flanking periods of manual control ( 4 hours each ) . Setting Neonatal intensive care unit . Participants Preterm infants ( n=20 ) on non-invasive respiratory support and supplemental oxygen , with oxygen saturation ( SpO2 ) target range 90%–94 % ( manual control ) and 91%–95 % ( automated control ) . Median gestation at birth 27.5 weeks ( IQR 26–30 weeks ) , postnatal age 8.0 ( 1.8–34 ) days . Intervention Automated oxygen control using a st and alone device , receiving SpO2 input from a st and ard oximeter and computing alterations to oxygen concentration that were actuated with a modified blender . The PID algorithm was enhanced to avoid iatrogenic hyperoxaemia and adapt to the severity of lung dysfunction . Main outcome measure Proportion of time in the SpO2 target range , or above target range when in air . Results Automated oxygen control result ed in more time in the target range or above in air ( manual 56 (48–63)% vs automated 81 (76–90)% , p<0.001 ) and less time at both extremes of oxygenation . Prolonged episodes of hypoxaemia and hyperoxaemia were virtually eliminated . The control algorithm showed benefit in every infant . Manual changes to oxygen therapy were infrequent during automated control ( 0.24/hour vs 2.3/hour during manual control ) , and oxygen requirements were unchanged ( automated control period 27 % , manual 27 % and 26 % , p>0.05 ) . Conclusions The novel PID algorithm was very effective for automated oxygen control in preterm infants , and deserves further investigation OBJECTIVE : The goal was to reduce adverse pulmonary adverse outcomes , oxidative stress , and inflammation in neonates of 24 to 28 weeks of gestation initially resuscitated with fractions of inspired oxygen of 30 % or 90 % . METHODS : R and omized assignment to receive 30 % ( N = 37 ) or 90 % ( N = 41 ) oxygen was performed . Targeted oxygen saturation values were 75 % at 5 minutes and 85 % at 10 minutes . Blood oxidized glutathione (GSSG)/reduced glutathione ratio and urinary o-tyrosine , 8-oxo-dihydroxyguanosine , and isoprostane levels , isofuran elimination , and plasma interleukin 8 and tumor necrosis factor α levels were determined . RESULTS : The low-oxygen group needed fewer days of oxygen supplementation ( 6 vs 22 days ; P < .01 ) and fewer days of mechanical ventilation ( 13 vs 27 days ; P < .01 ) and had a lower incidence of bronchopulmonary dysplasia at discharge ( 15.4 % vs 31.7 % ; P < .05 ) . GSSG/reduced glutathione × 100 ratios at day 1 and 3 were significantly higher in the high-oxygen group ( day 1 : high-oxygen group : 13.36 ± 5.25 ; low-oxygen group : 8.46 ± 3.87 ; P < .01 ; day 3 : high-oxygen group : 8.87 ± 4.40 ; low-oxygen group : 6.97 ± 3.11 ; P < .05 ) . Urinary markers of oxidative stress were increased significantly in the high-oxygen group , compared with the low-oxygen group , in the first week after birth . GSSG levels on day 3 and urinary isofuran , o-tyrosine , and 8-hydroxy-2′-deoxyguanosine levels on day 7 were correlated significantly with development of chronic lung disease . CONCLUSIONS : Resuscitation of preterm neonates with 30 % oxygen causes less oxidative stress , inflammation , need for oxygen , and risk of bronchopulmonary dysplasia BACKGROUND Mechanically ventilated very low birth weight infants often present with frequent episodes of  hypoxemia  , and maintaining arterial oxygen saturation by pulse oximetry ( SpO(2 ) ) within a normal range by manual fraction 
    Output:
    
Conclusion Automated FiO2 adjustment provides significant improvement of time in target saturations , reduces periods of hyperoxia , and severe hypoxia in preterm infants on positive pressure respiratory support