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Oxygen in neonatal anesthesia: friend or foe?

Sola, Augustoa,b

Current Opinion in Anaesthesiology:
doi: 10.1097/ACO.0b013e3282f8ad8d
Pediatric anesthesia: Edited by Bernard J. Dalens

Purpose of review: Clinical practices in oxygen administration are in need of change based on the increasing understanding of oxygen toxicity. Hypoxemia is due to many pathophysiological causes; avoiding hypoxemia is an important objective during neonatal anesthesia. Nevertheless, the only known cause for hyperoxemia is the excess and unnecessary administration of oxygen by healthcare providers. To avoid hyperoxemia is an important objective during neonatal anesthesia.

Recent findings: Neonatal exposure to 100% oxygen is almost never necessary. Much lower concentrations of inspired supplemental oxygen during the neonatal period can also lead to oxygen toxicity if oxygen is used when it is not necessary. Excess oxygen is associated with serious morbidities such as retinopathy of prematurity, bronchopulmonary dysplasia, injury to the developing brain, and childhood cancer. When providing supplemental oxygen, monitoring with modern Spo2 technology and avoidance of Spo2 values of 95–100% are less frequently associated with hyperoxemia.

Summary: Even brief neonatal exposures to pure oxygen must be avoided during neonatal anesthesia. When any dose of supplemental oxygen is given, a reliable pulse oximeter aiming to avoid hyperoxemia is necessary. Even though further research is essential, administration of oxygen by healthcare providers when it is not necessary is a foe and a neonatal health hazard.

Author Information

aMid Atlantic Neonatology Associates and Atlantic Neonatal Research Institute, Morristown, Atlantic Health System, USA

bUniversity of Medicine and Dentistry New Jersey, New Jersey, USA

Correspondence to Dr Augusto Sola, MD, Director of Neonatal Research and Academic Affairs, Division of Neonatology, Mid Atlantic Neonatology Associates and Atlantic Neonatal Research Institute, 100 Madison Ave, Morristown, NJ 07960, USA Tel: +1 973 971 8985; fax: +1 973 290 7175; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.