In 2023, over 4,000 children were born extremely prematurely in Germany alone, i.e. before the 28th week of pregnancy. They need additional oxygen via respiratory support systems because their immature lungs are not yet able to optimally supply the body with the gas. "The administration of oxygen is the most common measure in this patient group," says Prof. Dr. Andreas Flemmer, Head of Neonatology at LMU University Hospital Munich Großhadern and Hauner Children's Hospital: "Nevertheless, we hardly know anything about the optimal dose of supply." Too little means an undersupply; too much oxygen damages the lungs and the retina of the eyes to the point of detachment of the retina, which can lead to blindness. This happened to pop legend Stevie Wonder 75 years ago, for example.

In order to optimize the effect and risk of side effects, the oxygen supply should be precisely dosed within a narrow target range, depending on the oxygen saturation in the child's blood. However, infants often breathe very irregularly; in addition, the lung ventilation and function of small patients fluctuate. Nursing staff therefore have to constantly readjust the concentration of oxygen supplied by hand, which is a challenge given the scarcity of staff resources. Can machines with automated digital technology take over the adjustment of the oxygen supply and reduce both the rate of children's lung problems and the rate of retinal complications?

To find out, over 30 clinics in Germany and around the world have launched a study funded by the German Research Foundation (DFG). Over 1000 babies born between the 23rd and 27th week of pregnancy took part. They were divided into two groups. In group 1, the oxygen supply was regulated automatically. The premature babies in group 2 received the previous routine treatment with manual adjustment of the oxygen.

"In total across all participants," says Andreas Flemmer, "we did not see any statistically significant effect" - neither less lung damage nor fewer severe retinal problems nor fewer children dying from the complications of their prematurity.

The evaluation of the overall study also showed that automatic oxygen regulation has no adverse effects on the small patients. This means, as the Munich neonatologist says: "This technology can be used, which relieves the nursing staff enormously 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." All in all, Andreas Flemmer sums up, "a worthwhile, practice-changing study."