The Use and Misuse of Oxygen During the Neonatal Period

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Introduction

Life as we know it in biologic systems depends on the ability of overcoming entropy which is the natural tendency towards molecular disorder. To overcoming entropy a great amount of energy is necessary. The present review addresses the relevance of aerobic metabolism as the most efficient means of obtaining energy from metabolic substrates rendering oxygen indispensable for life. However, as a counterpart negative aspects of oxidative metabolism will also be addressed.

Section snippets

Aerobic metabolism

Oxygen is one of the most abundant elements in nature and also one of the most widely used drugs in neonatology (Fig. 1).1 Because of its specific properties, oxygen has evolved to become indispensable to sustain life in multicellular organisms. Hence, oxygen is completely available, diffuses easily across biologic membranes, and can bind to heme in proteins, such as hemoglobin and cytochromes in mitochondria.2 Of note, with the concourse of oxygen, cells are capable to build up sufficient ATP

Fetal to neonatal transition

Fetal life develops in an environment that is relatively hypoxic compared with the extrauterine world; hence, arterial partial pressure of oxygen (paO2) in utero is of 25 to 35 mm Hg in the general circulation and even less (17–19 mm Hg) in the pulmonary circulation.8 Although seemingly isolated from the external milieu, the fetus is highly susceptible to changes in oxygenation induced in the mother. Hence, recent studies have shown that the paO2 of fetuses whose mothers received oxygen

Oxygen during neonatal care in the NICU

The conundrum regarding the establishment of upper and lower limits of oxygen saturation, especially in ELBW infants, is still open. ELBW infants are very sensitive to both hyperoxia, which may especially lead to lung and retinal damage, and to hypoxia, which may cause white matter injury.23 Studies that have compared different limits for SpO2 have concluded that neonatal units maintaining ELBW infants within low saturation limits (85%–95%) have a significantly lower incidence (∼50%) of

Evolving oxygen needs in the first weeks of life and new metabolic indices

Recent studies have suggested that it would be possible to differentiate between 2 different periods with different oxygen limits.36 Very preterm infants at fewer than 32 weeks of postconceptional age would theoretically benefit from lower SpO2 limits (eg, 85%–95%). In a phase of rapid vascular growth and extreme tissue sensitivity to oxygen because of an immature antioxidant defense system, the use of higher oxygen limits would lead to oxidative stress and inflammation in the lung, intestine,

Going home on oxygen

Chronic lung disease and prolonged oxygen needs among extremely preterm infants (≤28 weeks’ gestation) is still a matter of concern. Of note, a relevant number of these babies are still being discharged home from the hospital on supplemental oxygen.38 The goal of home oxygen therapy is to prevent the effects of chronic hypoxemia, which include pulmonary vasoconstriction leading to pulmonary hypertension, bronchial constriction leading to airway obstruction, and changes in growth of pulmonary

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    Disclosure Statement: None of the authors of this article has any commercial or financial relation to disclose.

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