Why are we still using oxygen to resuscitate term infants?

Area of Science:

• Neonatal Medicine
• Pediatric Resuscitation
• Clinical Practice Guidelines

Background:

• Historical use of high-concentration oxygen in newborn resuscitation.
• Emerging research questioning the efficacy and safety of high-oxygen protocols.
• The need for evidence-based adjustments in neonatal care practices.

Purpose of the Study:

• To summarize the evolution of oxygen use in newborn resuscitation.
• To present evidence supporting a shift towards lower oxygen concentrations.
• To provide guidance on oxygen administration for different neonatal populations.

Main Methods:

• Review of historical data and clinical practice evolution.
• Analysis of findings from a recent Cochrane review on oxygen use.
• Synthesis of available data on resuscitation outcomes for various infant groups.

Main Results:

• A shift from high (100%) to low (21%) oxygen in resuscitation may save >100,000 newborn lives globally per year.
• Low-oxygen approach is recommended for term and late preterm infants.
• Specific oxygen concentrations (21-30%) are suggested for extremely low birth weight infants, adjusted by response.

Conclusions:

• Changing to a low-oxygen approach (21%) in newborn resuscitation represents a major advancement in reducing neonatal mortality.
• While beneficial for most, extremely preterm infants may require individualized oxygen supplementation.
• Further research is needed to establish strict guidelines for the most vulnerable preterm neonates.