Why oxygen transition matters

• Prematurity burden

​Premature birth remains one of the most significant correlations with life-long disability. Until premature births become preventable, clinicians must apply the best tools and methods to support the vital functions of these highly vulnerable infants while avoiding inadvertent injury.

• Oxygen exposure

The normal fetal environment prior to birth offers stability of temperature, constant nourishment, and supply of oxygen at a relatively low level that appears to be sufficient and even required for normal fetal development. 

• Transition physiology

Upon birth, all newborn infants need to immediately transition to obtaining oxygen through breathing. This primarily involves both establishing the mechanical and gas exchange functions of the lungs and accommodating the doubling of oxygen available from breathing air, or with oxygen therapy, even higher oxygen exposure. Birth also brings the new need for closely regulated breathing during sleep. The need for oxygen increases dramatically following birth to support the increased energy needs for muscular work, establishing thermal stability, and sustaining growth and development. Without awareness of the status of cellular adaptation to the oxygen supply immediately prior to birth, and with only blood oxygen monitoring following birth, it is our hypothesis that today’s clinicians do not have the tools needed to guide the "safe and effective" supply of oxygen without risking triggering a “reperfusion injury-like” response that results in injuries to the infant's eyes, brain, gut, and ductus from too-rapid increase in oxygen supply. Near-term and term newborn infants who were deeply stressed prior to birth may suffer more generalized HIE injuries.

• Systems limitations

Existing medical devices available for transition care of premature and stressed newborn infants were apparently designed with the assumption that “real care” begins in the NICU. As a result, the critical first few minutes of transition, when the root cause triggering events likely occur, is currently left with incomplete biometric guidance and limited functional support. Once the pathologic sequence is triggered, it appears that the injury cascade continues to progress and may only be partially mitigated by expert NICU care and future rehabilitation. Fluctuations in oxygen supply during NICU care are primarily due to changes in lung function, but also involve immature regulation of breathing during sleep in the form of periodic breathing, which may result in episodes of prolonged apnea needing recognition and resuscitation. Oxygen is one of the most-used pharmaceuticals in modern medical care. Surgical anesthesia and cardiopulmonary bypass procedures typically apply oxygen liberally in an effort to avoid hypoxemia-associated injuries. We offer new biometric indicators of cellular oxygen status that appear in preliminary studies to be more physiologically relevant than blood oxygen measurements during birth transition, surgical anesthesia, resuscitation, and reperfusion therapy. It is our hope that continued investigation with this new technology and information will enable safer and more effective use of medical oxygen throughout the human lifespan.