Abstract
The amount of oxygen given to preterm infants within the first few minutes of birth is one of the most contentious issues in modern neonatology. Just two decades ago, pure oxygen (FiO2 1.0) was standard of care and oximetry monitoring was not routine. Due to concerns about oxidative stress and injury, clinicians rapidly adopted the practice of using less oxygen for the respiratory support of all infants, regardless of gestational maturity and pulmonary function. There is now evidence that initial starting fractional inspired oxygen may not be the only factor involved in providing optimum oxygenation and that the amount of oxygen given to babies within the first 10 min of life is a crucial factor in determining outcomes, including death and neurodevelopmental injury. In addition, evolving practice, such as non-invasive respiratory support and delayed cord clamping, need to be taken into consideration when considering oxygen delivery to preterm infants. This review will discuss evidence to date and address the major knowledge gaps that need to be answered in this pivotal aspect of neonatal practice.
Highlights
The optimum amount of oxygen required for the respiratory support of newborn infants is one of the most contentious issues in current neonatal practice
In the 1990s, the Resair study raised the possibility that room air (FiO2 0.21) could be used instead of pure oxygen for newborn resuscitation [1]
This study showed that air could be used as safely as oxygen to initiate the resuscitation of hypoxic full-term infants
Summary
The optimum amount of oxygen required for the respiratory support of newborn infants is one of the most contentious issues in current neonatal practice. As recently as the 1960s, oxygen was considered “only to be good” and clinicians were advised to “use (it) liberally” [2], especially with knowledge that birth-related neurological injury could be related to hypoxia [3]. In the 1990s, the Resair study raised the possibility that room air (FiO2 0.21) could be used instead of pure oxygen for newborn resuscitation [1]. This study showed that air could be used as safely as oxygen to initiate the resuscitation of hypoxic full-term infants. Over the 15 years, an increasing number of studies [7,8,9,10,11,12,13] showed that air resuscitation was possible and that using air considerably reduced oxidative stress and injury to major organs such as the heart and kidneys [9]. In 2005, a meta-analysis of >1,300 infants by Tan et al provided compelling evidence that air resuscitation could decrease the risk of death in hypoxic infants by about 30% when compared to oxygen resuscitation (typical Odds Ratio (OR) 0.69, 95% Confidence Intervals (CI): 0.54–0.88; 14)
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