Computer model of oxygenation in neonates: A demonstration of utility

Maintaining a prescribed peripheral oxygen saturation (SpO 2 ) target during routine care of neonates is challenging and inspired fraction of oxygen (FiO 2 ) titration practices differ among caregivers and centers. Algorithms for automatic feedback control of SpO 2 are being developed and tested, that would adapt to the changing neonatal organism and better maintain the required SpO 2 target range. While clinical data is necessary to validate differences in the titration strategies, a continuous physiological model of oxygenation in neonates would facilitate baseline testing of different approaches, manual or automated. The objective of our study was to enhance a mathematical model of oxygenation of the neonate and to compare the performance of the model with available clinical data. We have implemented the diffusion resistance into the model as well as a variable oxyhemoglobin dissociation relationship and the bias between arterial and peripheral oxygen saturation. Values of model parameters were scaled to fit preterm infant scenarios. The comparison of the clinical data and computer simulations suggest that the model can reliably simulate episodes of oxygen desaturation and describe the relation between ventilation, FiO 2 and SpO 2 . It appears that the model may be an effective tool to test manual and automatic FiO 2 titration strategies.