Oxidative stress in resuscitation and in ventilation of newborns
E Gitto1, S Pellegrino, S D'Arrigo
1Institute of Medical Paediatrics, Neonatal Intensive Care Unit, University of Messina, Messina, Italy.
Insights
Newborns are vulnerable to oxidative stress, especially during resuscitation with pure oxygen. Avoiding mechanical ventilation, using continuous positive airway pressure, may reduce lung injury in neonates.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Biomedical Science
Background:
- Newborn lungs are susceptible to oxidative damage from reactive oxygen and nitrogen species.
- Infants often face increased risk factors including high oxygen exposure, infections, inflammation, reduced antioxidant defenses, and high iron levels.
- Oxidative stress is implicated in various neonatal conditions, termed 'oxygen radical diseases of neonatology'.
Purpose of the Study:
- To review the scientific evidence on oxidative stress in newborn resuscitation and ventilation.
- To evaluate the impact of different ventilation strategies on neonatal outcomes.
- To explore the role of oxygen concentrations during resuscitation.
Main Methods:
- Literature review of scientific evidence.
- Analysis of studies on resuscitation and ventilation strategies in newborns.
- Examination of factors contributing to oxidative stress in neonates.
Main Results:
- Resuscitation with pure oxygen may increase oxidative stress compared to ambient air.
- Nasopharyngeal continuous positive airway pressure is suggested as a potentially more effective ventilatory strategy than mechanical ventilation.
- Various ventilation strategies have been explored to mitigate injury and improve outcomes.
Conclusions:
- Oxidative stress is a significant concern in neonatal care, particularly during resuscitation.
- Ventilation strategies significantly impact neonatal lung injury and outcomes.
- Minimizing mechanical ventilation in favor of methods like continuous positive airway pressure may be beneficial for newborns.
Abstract:
The lungs of newborns are especially prone to oxidative damage induced by both reactive oxygen and reactive nitrogen species. Yet, these infants are often 1) exposed to high oxygen concentrations, 2) have infections or inflammation, 3) have reduced antioxidant defense, and 4) have high free iron levels which enhance toxic radical generation. Oxidative stress has been postulated to be implicated in several newborn conditions with the phrase "oxygen radical diseases of neonatology" having been coined. There is, however, reason to believe that oxidative stress is increased more when resuscitation is performed with pure oxygen compared with ambient air and that the most effective ventilatory strategy is the avoidance of mechanical ventilation with the use of nasopharyngeal continuous positive airway pressure whenever possible. Multiple ventilation strategies have been attempted to reduce injury and improve outcomes in newborn infants. In this review, the authors summarise the scientific evidence concerning oxidative stress as it relates to resuscitation in the delivery room and to the various modalities of ventilation.
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