Oxygen for newborn resuscitation: a narrative review ; ENEngelskEnglishOxygen for newborn resuscitation: a narrative review

Background and Objective: Supplemental oxygen was used for newborn resuscitation for the first 200 years after its discovery; however, over the last 50 years the safety of this practice has been called into question. Discovery of hypoxanthine, which is produced under anaerobic conditions and when oxidized produces free radicals, called into question the safety of supplemental oxygen following a hypoxic period, especially intrauterine hypoxia. The goal of this review is to examine the bench to bedside transition of this field of research and how it led to practice change regarding neonatal resuscitation in the delivery room. Methods: In order to synthesize key findings for the objectives of this review, we searched literature published up to August 31, 2021 using PubMed with the following keywords: “Hypoxanthine”, “Hypoxia”, and “Oxidative stress”; with a second search including the terms “Neonatal”, “Resuscitation”, “Oxygen”, “Room air”. Key Content and Findings: The early neonatal hypoxanthine studies coincided with an increased appreciate for oxidative injury that happens following hypoxia-reperfusion, such as neonatal resuscitation following intrauterine asphyxia. Based on 10 feasibility and safety studies in infants mostly >35 weeks gestation, resuscitation with air proved to be superior to 100% O2 in mortality which led to a change in the standard of care. The physiology that causes a preterm infant to require resuscitation at birth is not the same as term infants; therefore, these infants require oxygen supplementation during resuscitation although unavoidable oxidative stress from this necessary oxygen exposure does occur. Conclusions: Today it is recommended to start with air in the delivery room if term or near-term newborn infants need positive pressure ventilation (PPV) immediately after birth. This discovery may prevent up to half a million newborn deaths annually. For premature infants <35 weeks gestational age supplemental oxygen may be needed; however, the optimal initial oxygen ...