Oxygen supplementation during neonatal resuscitation- Too little vs too much, does it matter?

Saturday, April 26, 2025

10:00am – 11:30am HST

Location: Convention Center: Kalākaua Ballroom A (Level 4)

CE: 1.5

Selected By: Neonatal

Chair(s)

Ola Didrik Saugstad, MD, PhD (he/him/his)

professor
University of Oslo and Ann & Robert H. Lurie Children's Hospital of Chicago, University of Oslo, Norway
Oslo, Norway
Deepika Sankaran, MD (she/her/hers)

Associate Professor of Pediatrics
Pediatrics
University of California Davis Children's Hospital
University of California, Davis
Sacramento, California, United States

Disclosure(s):

Ola Didrik Saugstad, MD, PhD: Karger Publishers (Ongoing) (Products/Services: Board Member or Executive Role)

Deepika Sankaran, MD: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Oxygen (O2) is the most frequently used drug in neonatal resuscitation. During advanced cardiopulmonary resuscitation including chest compressions for neonatal bradycardia and cardiac arrest, the International Liaison Committee on Resuscitation advocates to increase inspired O2 to 100%. However, similar ROSC outcomes are reported with the use of lower inspired O2 during chest compressions.1 Hyperoxia may be harmful in the post-resuscitation period.2 Oxygen free radicals are important contributors to brain injury in perinatal asphyxia.3 Judicious use of O2 is warranted to minimize lung and brain tissue injury, and improve long-term outcomes. On the contrary, achieving SpO2 >80% and heart rate >100bpm by 5 min after birth are associated with improved outcomes in preterm infants.4 Clinical trials are ongoing to investigate the use of higher inspired O2 during deferred cord clamping to achieve early oxygenation while avoiding hyperoxia.5
1. Garcia-Hidalgo C et al. A Review of Oxygen Use During Chest Compressions in Newborns-A Meta-Analysis of Animal Data. Front Pediatr. 2018;6:400.
2. Kapadia VS et al. Perinatal asphyxia with hyperoxemia within the first hour of life is associated with moderate to severe hypoxic-ischemic encephalopathy. J Pediatr. 2013;163(4):949-954.
3. Saugstad OD et al. Oxygen therapy of the newborn from molecular understanding to clinical practice. Pediatric Research. 2019;85(1):20-29.
4. Oei JL et al. Outcomes of oxygen saturation targeting during delivery room stabilisation of preterm infants. ADC Fetal and Neonatal Ed. 2018;103(5):F446-f454.
5. Lakshminrusimha S et al. Differential Alveolar and Systemic Oxygenation during Preterm Resuscitation with 100% Oxygen during Delayed Cord Clamping. Am J Perinatol. 2023;40(6):630-637.

Learning Objectives:

understand the physiology of oxygen utilization during resuscitation.
review current literature on optimal oxygen supplementation during resuscitation and target saturations in term and preterm infants.
explore knowledge gaps and future areas of research in oxygen supplementation and targeting in newborns during resuscitation.

Presentations:

10:00am – 10:15am HST

Oxygenation During Deferred Cord Clamping
Speaker: Anup Katheria, MD – Sharp Mary Birch Hospital for Women & Newborns
10:15am – 10:30am HST

Hyperoxia and Oxidative Stress
Speaker: Ola Didrik Saugstad, MD, PhD (he/him/his) – University of Oslo and Ann & Robert H. Lurie Children's Hospital of Chicago, University of Oslo, Norway
10:30am – 10:45am HST

Oxygen Supplementation During Resuscitation of Preterm Infants
Speaker: Vishal Kapadia, MD MSCS FAAP – University of Texas Southwestern Medical School
10:45am – 11:00am HST

Oxygen Use During Chest Compressions
Speaker: Deepika Sankaran, MD (she/her/hers) – University of California Davis Children's Hospital
11:00am – 11:15am HST

Oxygenation in the Post-resuscitation Period and During Therapeutic Hypothermia
Speaker: Satyan Lakshminrusimha, MD (he/him/his) – UC Davis
11:15am – 11:30am HST

Q & A