Several studies demonstrated an increase in time spent within target range when automated oxygen control (AOC) is used. However the effect on clinical outcome remains unclear. We compared clinical outcomes of preterm infants born before and after implementation of AOC as standard of care. In a retrospective pre-post implementation cohort study of outcomes for infants of 24–29 weeks gestational age receiving respiratory support before (2012–2015) and after (2015–2018) implementation of AOC as standard of care were compared. Outcomes of interest were mortality and complications of prematurity, number of ventilation days, and length of stay in the Neonatal Intensive Care Unit (NICU). A total of 588 infants were included (293 pre- vs 295 in the post-implementation cohort), with similar gestational age (27.8 weeks pre- vs 27.6 weeks post-implementation), birth weight (1033 grams vs 1035 grams) and other baseline characteristics. Mortality and rate of prematurity complications were not different between the groups. Length of stay in NICU was not different, but duration of invasive ventilation was shorter in infants who received AOC (6.4 ± 10.1 vs 4.7 ± 8.3, p = 0.029).Conclusion: In this pre-post comparison, the implementation of AOC did not lead to a change in mortality or morbidity during admission. What is Known:• Prolonged and intermittent oxygen saturation deviations are associated with mortality and prematurity-related morbidities.• Automated oxygen controllers can increase the time spent within oxygen saturation target range.What is New:• Implementation of automated oxygen control as standard of care did not lead to a change in mortality or morbidity during admission.• In the period after implementation of automated oxygen control, there was a shift toward more non-invasive ventilation.

Faster resolution of hypoxaemic or hyperoxaemic events in preterm infants may reduce long-term neurodevelopmental impairment. Automatic titration of inspiratory oxygen increases time within the oxygen saturation target range and may provide a more prompt response to hypoxic and hyperoxic events. We assessed routinely performed follow-up at two years of age after implementation of automated oxygen control (AOC) as standard care and compared this with a historical cohort. Neurodevelopmental outcomes at two years of age were compared for infants born at 24–29 weeks gestational age before (2012–2015) and after (2015–2018) implementation of AOC as standard of care. Primary outcome was a composite outcome of either mortality or severe neurodevelopmental impairment (NDI), other outcomes assessed were mild-moderate NDI, Bayley-III composite scores, cerebral palsy GMFCS and CBCL problem behaviour scores. 289 infants were eligible in the pre-AOC epoch and 292 in the post-AOC epoch. Baseline characteristics were not significantly different. 51 infants were lost to follow-up (pre-AOC 6.9% (20/289), post-implementation 10.6% (31/292)). The composite outcome of mortality or severe NDI was observed in 17.9% pre-AOC (41/229) vs. 24.0% (47/196) post-AOC (p = 0.12). No significant differences were found for the secondary outcomes such as mild-moderate NDI, Bayley-III composite scores, cerebral palsy GMFCS and problem behaviour scores, with the exception of parent-reported readmissions until moment of follow-up which was less frequent post-AOC than pre-AOC. Conclusion In this cohort study, Implementation of automated oxygen control in our NICU as standard of care for preterm infants led to no statistically significant difference in neurodevelopmental outcome at two years of age.