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Aspects on Oxygenation in Preterm Infants before, Immediately after Birth, and Beyond
James X Sotiropoulos1, Ola D Saugstad2,3, Ju Lee Oei4,5,6
1NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.
Insights
Balancing oxygen levels is critical for preterm infants, from before birth through infancy. Current technologies struggle to manage both dangerously low (hypoxia) and high (hyperoxia) oxygen levels, posing risks to vulnerable newborns.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Biomedical Engineering
Background:
- Oxygen is essential for life, but both hypoxia and hyperoxia can be detrimental, leading to severe health consequences.
- Preterm infants possess immature physiological systems, compromising their ability to regulate oxygen balance effectively.
- The critical window for oxygen management extends from fetal development through neonatal care and post-discharge monitoring.
Purpose of the Study:
- To review the complexities and challenges in maintaining optimal oxygenation in preterm infants.
- To highlight the risks associated with both insufficient and excessive oxygen exposure in neonates.
- To identify limitations in current technologies and services for precise oxygen monitoring and control.
Main Methods:
- Literature review of existing evidence on oxygen management in preterm infants.
- Analysis of physiological challenges in oxygen homeostasis during the neonatal period.
- Examination of technological and clinical service gaps in intensive care settings.
Main Results:
- Preterm infants require careful oxygen supplementation to prevent hypoxia due to underdeveloped lungs.
- Immature antioxidant defenses in preterm infants increase susceptibility to hyperoxia-related injury.
- Significant challenges exist in achieving safe and effective oxygen therapy for newborns with current medical capabilities.
Conclusions:
- Striking a balance in oxygen therapy is paramount, especially during the transition to extrauterine life.
- Advanced monitoring and responsive interventions are needed to mitigate risks of hypoxia and hyperoxia in preterm infants.
- Overcoming current limitations is essential for improving the long-term outcomes of preterm infants receiving oxygen therapy.
Background:
Oxygen is crucial for life but too little (hypoxia) or too much (hyperoxia) may be fatal or cause lifelong morbidity.
Summary:
In this review, we discuss the challenges of balancing oxygen control in preterm infants during fetal development, the first few minutes after birth, in the neonatal intensive care unit and after hospital discharge, where intensive care monitoring and response to dangerous oxygen levels is more often than not, out of reach with current technologies and services.
Key Messages:
Appropriate oxygenation is critically important even from before birth, but at no time is the need to strike a balance more important than during the first few minutes after birth, when body physiology is changing at its most rapid pace. Preterm infants, in particular, have a poor control of oxygen balance. Underdeveloped organs, especially of the lungs, require supplemental oxygen to prevent hypoxia. However, they are also at risk of hyperoxia due to immature antioxidant defenses. Existing evidence demonstrate considerable challenges that need to be overcome before we can ensure safe treatment of preterm infants with one of the most commonly used drugs in newborn care, oxygen.
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