The Neonatal Resuscitation Program (NRP) has progressed over 25 years from assumptions and professional opinion about resuscitation of the term infant to evidence-based recommendations for the initial support of both term and preterm infants. This evidence base has been developed by interested investigators using traditional and newer monitoring techniques to measure the transitions in oxygenation, cardiopulmonary function, and metabolism following birth. Supplemental oxygen can cause oxidant exposures that may cause long-term organ injury. As the monitoring has improved, the challenges are to learn if monitoring can change outcomes rather than simply improve physiologic variables that may not impact long-term outcomes. The report by Kenosi et al illustrates this point. They evaluated cerebral oxygenation immediately following delivery of preterm infants with the hypothesis that those infants that received >30% oxygen would have more brain regional oxygen saturations >85% and, thus, the possibility of oxidant injury relative to infants receiving <30%. They found no difference in >85% saturation values between the groups, but more of the infants receiving >30% oxygen had saturations <55%, indicating brain hypoxia. The infants requiring more oxygen had more lung immaturity and presumably a less mature cardiovascular adaptation to birth. This report demonstrates interesting but transient differences in cerebral oxygen saturations. But, the bigger challenge will be to evaluate if the differences are clinically relevant and if measurements of cerebral oxygen saturation are of value during delivery, beyond experimental studies. The physiology is fascinating, and more studies are required to identify which measurements can improve outcomes.Article page 1007▶ The Neonatal Resuscitation Program (NRP) has progressed over 25 years from assumptions and professional opinion about resuscitation of the term infant to evidence-based recommendations for the initial support of both term and preterm infants. This evidence base has been developed by interested investigators using traditional and newer monitoring techniques to measure the transitions in oxygenation, cardiopulmonary function, and metabolism following birth. Supplemental oxygen can cause oxidant exposures that may cause long-term organ injury. As the monitoring has improved, the challenges are to learn if monitoring can change outcomes rather than simply improve physiologic variables that may not impact long-term outcomes. The report by Kenosi et al illustrates this point. They evaluated cerebral oxygenation immediately following delivery of preterm infants with the hypothesis that those infants that received >30% oxygen would have more brain regional oxygen saturations >85% and, thus, the possibility of oxidant injury relative to infants receiving <30%. They found no difference in >85% saturation values between the groups, but more of the infants receiving >30% oxygen had saturations <55%, indicating brain hypoxia. The infants requiring more oxygen had more lung immaturity and presumably a less mature cardiovascular adaptation to birth. This report demonstrates interesting but transient differences in cerebral oxygen saturations. But, the bigger challenge will be to evaluate if the differences are clinically relevant and if measurements of cerebral oxygen saturation are of value during delivery, beyond experimental studies. The physiology is fascinating, and more studies are required to identify which measurements can improve outcomes. Article page 1007▶ Effects of Fractional Inspired Oxygen on Cerebral Oxygenation in Preterm Infants following DeliveryThe Journal of PediatricsVol. 167Issue 5PreviewTo explore regional cerebral oxygen saturations (rcSO2) in preterm neonates initially stabilized with 0.3 fractionated inspired oxygen (FiO2) concentrations. We hypothesized that those infants who received >0.3 FiO2 during stabilization following delivery would have relatively higher rcSO2 postdelivery compared with those stabilized with a lower FiO2. Full-Text PDF