Affiliations: Division of Neonatology, University Hospital La Fe,
Valencia, Spain
Note: [] orresponding author: Maximo Vento, PhD, MD, Division of
Neonatology, University Hospital La Fe, Avenida de Campanar, 21, E46009
Valencia, Spain. Tel.: +34 96 386 2791; Fax: +34 96 197 3408; E-mail:
[email protected]; [email protected]
Abstract: Fetal to neonatal transition is characterized by an abrupt increase
in the arterial partial pressure of oxygen and oxygen delivery to the tissue
both causing a physiologic pro-oxidant status. Under normal circumstances
arterial oxygen saturation measured by preductal pulse oximetry in term babies
does not reach consistent values (85–90%) until four to five minutes after
cord clamping, and 7 to 10 minutes in preterm infants. Of note, the time needed
to stabilize saturation inversely correlates with gestational age. Oxygen in
excess causes oxidative stress and inflammation in preterm infants. In order to
avoid these negative consequences the inspiratory fraction of oxygen should be
titrated until achievement of stable and safe oxygen saturation. Remarkably,
the availability of an oxygen saturation nomogram could be of great help for
the care givers. Supplementing the newborn with high inspiratory fractions of
oxygen pursuing to rapidly achieve high oxygen saturation should be avoided.
Instead, a proposal consisting in initiating resuscitation with lower oxygen
inspiratory fractions and titrating according to targeted saturations is
proposed. Multicenter international prospective randomized clinical trials
powered to evaluate oxygen administration in the first minutes of life and
neurodevelopment at two years are being launched at present and hopefully will
clarify many of our doubts.
