Oxygen during Neonatal Resuscitation: Too Much versus Too Little, Does It Matter?

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Respiratory Physiology

Background:

• Oxygen has been used in neonatal resuscitation for nearly 200 years.
• Historical shifts occurred from 100% to 21% oxygen due to adverse outcomes.
• Current evidence suggests risks of both hypoxia and hyperoxia, especially in preterm infants.

Purpose of the Study:

• To review current evidence on oxygen use in neonatal resuscitation.
• To explore the impact of hyperoxia in various neonatal scenarios.
• To refine oxygen management strategies for improved neonatal outcomes.

Main Methods:

• Literature review of current evidence on oxygen administration.
• Analysis of oxygen use during delayed cord clamping, resuscitation, and post-resuscitation.
• Examination of the effects of hyperoxia on neonatal health.

Main Results:

• Evidence suggests a delicate balance is needed between hypoxia and hyperoxia.
• Oxygen management strategies require refinement for different gestational ages and conditions.
• Optimal oxygen levels during resuscitation remain an active area of research.

Conclusions:

• Further research is needed to address knowledge gaps in neonatal oxygenation.
• Recommendations include starting resuscitation with 0.3-1 FiO2 for VLBW infants, titrating to target SpO2.
• Target SpO2 of 80-85% by 5 minutes is suggested for preterm infants.