Oxygen in neonatal anesthesia: friend or foe?

Clinical practices in oxygen administration are in need of change based on the increasing understanding of oxygen toxicity. Hypoxemia is due to many pathophysiological causes; avoiding hypoxemia is an important objective during neonatal anesthesia. Nevertheless, the only known cause for hyperoxemia is the excess and unnecessary administration of oxygen by healthcare providers. To avoid hyperoxemia is an important objective during neonatal anesthesia.

Neonatal exposure to 100% oxygen is almost never necessary. Much lower concentrations of inspired supplemental oxygen during the neonatal period can also lead to oxygen toxicity if oxygen is used when it is not necessary. Excess oxygen is associated with serious morbidities such as retinopathy of prematurity, bronchopulmonary dysplasia, injury to the developing brain, and childhood cancer. When providing supplemental oxygen, monitoring with modern SpO2 technology and avoidance of SpO2 values of 95-100% are less frequently associated with hyperoxemia.

Even brief neonatal exposures to pure oxygen must be avoided during neonatal anesthesia. When any dose of supplemental oxygen is given, a reliable pulse oximeter aiming to avoid hyperoxemia is necessary. Even though further research is essential, administration of oxygen by healthcare providers when it is not necessary is a foe and a neonatal health hazard.