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When is supplemental oxygen indicated in the newborn?
Controversy, controversy, controversy! There are growing data in the literature that both not enough oxygen and too much oxygen, even brief exposure to excessive levels during resuscitation, are harmful to the newly born infant. The oxygen saturation level does not reach extrauterine values until several minutes after birth, which may result in the appearance of cyanosis. It has been shown that absence of cyanosis is also a poor indicator of oxygenation after birth. Place a pulse oximeter with a neonatal probe on the newly born infant in a preductal location (right wrist or right medial surface of the palm) if resuscitation is anticipated, when positive-pressure ventilation is initiated, when cyanosis persists, or when supplemental oxygen is administered. Initiate resuscitation with air or blended oxygen and titrate with the goal of an oxygen saturation in the interquartile range of preductal saturation percentages shown in the below table.
Target Preductal SpO2 After Birth
| Time | Sp o 2 |
|---|---|
| 1 min | 60-65% |
| 2 min | 65-70% |
| 3 min | 70-75% |
| 4 min | 75-80% |
| 5 min | 80-85% |
| 10 min | 85-95% |
Sources
Kattwinkel J, Perlman JM, Aziz K, et al: Part 15: Neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122(18 Suppl 3):S909-S919.
Rabi Y, Rabi D, Yee W: Room air resuscitation of the depressed newborn: A systematic review and meta-analysis. Resuscitation 2007;72:353-363.
Vento M, Asensi M, Sastre J, et al: Resuscitation with room air instead of 100% oxygen prevents oxidate stress in moderately asphyxiated term neonates. Pediatrics 2001;107(4):642-647.
