Oxygen for Newborn Resuscitation: How Much Is Enough?

Abstract

The new guidelines for newborn resuscitation from the American Heart Association (AHA), the International Liaison Committee on Resuscitation (ILCOR), and the European Resuscitation Council are based on the International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations of 2005.1,2 Since the publication of the previous guidelines from the ILCOR and AHA in 1999 and 2000,3,4 controversial issues within neonatal resuscitation have been identified, and a consensus was reached on (1) the role of supplementary oxygen, (2) peripartum management of meconium, (3) ventilation strategies, (4) devices to confirm placement of an advanced airway, (5) medications, (6) maintenance of body temperature, (7) postresuscitation management, and (8) considerations for withholding and discontinuing resuscitation. In this commentary we discuss the use of supplementary oxygen only. When considering the guidelines provided by the AHA in 1992, the change in attitude regarding use of supplementary oxygen has been substantial. In 1992 it was clearly stated that resuscitation should be conducted with oxygen and that such a brief exposure of pure oxygen is not harmful: “Hypoxia is nearly always present in the newborn requiring resuscitation at birth. Therefore, if cyanosis, bradycardia, or other signs of neonatal distress are noted in a breathing newborn during stabilization, early administration of 100% oxygen is important.”5 In addition: “The hazards of administering too much oxygen during the brief period required for resuscitation should not be a concern.”5 In the AHA guidelines from 2000 it still was stated that 100% oxygen should be used if ventilation is needed: “If assisted ventilation is required, 100% oxygen should be delivered by positive pressure ventilation” and “[i]f supplemental oxygen is not available, resuscitation of the newly born infant should be initiated with positive pressure ventilation and room air.”4 At that time … Address correspondence to Ola Didrik Saugstad, MD, PhD, Department of Pediatric Research, Rikshospitalet University Hospital, 0027 Oslo, Norway. E-mail: o.d.saugstad{at}medisin.uio.no