Oxygen for the preterm newborn: one infant at a time.

摘要

The randomized trial by Wang et al compares short-term outcomes of infants who were 23 to 32 weeks' gestation and initially were given 1 of 2 fraction of inspired oxygen (F_(IO_2)) extremes (0.21 or 1.0) for delivery room resuscitation. "Too much" oxygen in the blood is a health hazard, and health care providers are the only known cause of neonatal hyperoxemia. Wang et al show that 100% O_2 is not needed for most preterm infants during the transition period. Within 2 minutes, pulse oxygen saturation (Sp_(O_2)) may reach values that are associated with high Pa_(O_2) and release "dastardly chemicals." Likewise, infants can be made hyperoxemic without "pure O_2." If after the transition period the F_(IO_2) is increased "a little" (5%-10%) as a "precautionary routine" measure when not needed, then significant hyperoxemia can occur in a few seconds, as can be understood from cardiopulmonary physiology and the alveolar gas equation; therefore, pure oxygen or any preemptive F_(IO_2) increase should be eradicated from practice in the delivery room, NICU, surgical suite, or elsewhere.