Why oxygen transition matters

• Prematurity burden

​     Premature birth correlates with significant extra burdens for the infant and its parents and, far too-often, with life-long disability for that person. Until premature birth becomes preventable, clinicians must apply the best available 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 body 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 supplemental oxygen therapy, even higher oxygen exposure. The need for oxygen increases dramatically following birth to support the increased energy demands of muscular work, establishing and maintaining thermal stability, and 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 by pulse oximetry and blood gas measurement following birth, it is our hypothesis that today’s clinicians do not have all of the information needed to guide the "safe and effective" supply of oxygen during birth transition. Supplying insufficient oxygen risks hypoxic injury. Supplying too much oxygen, or increasing oxygen supply more rapidly than the infant's cells can adapt, risks triggering a “reperfusion injury-like” response that may result in injuries to the infant's eyes, brain, gut, and ductus. Near-term and term newborn infants who were deeply stressed prior to birth may suffer more generalized HIE injuries.

• Systems limitations

     The design of medical devices available for transition care of premature and stressed newborn infants apparently assumes that “real care” begins in the NICU. As a result, the critical first few minutes of birth transition is currently supplied with incomplete biometric guidance and limited functional support. Once the pathologic sequence for the above-listed injuries is triggered, it appears that the injury cascade continues to progress and may only be partially mitigated by expert NICU care and future rehabilitation. Additional variations in oxygen intake during NICU care may be due to changes in lung function, but may also involve immature regulation of the infant's breathing during sleep. The most common abnormal breathing pattern is periodic breathing, resulting in intermittent hypoxemia (IH), which, if progressive in severity, may result in episodes of prolonged apnea needing resuscitation, including apnea of prematurity (AOP) and apnea/bradycardia (AB). The new CEi indicator of cellular oxygen status appears in preliminary studies with adults to be more responsive and more physiologically relevant than blood oxygen measurements during hypoxic stress. It is our hope that continued investigation with this new technology and information will enable safer and more effective use of medical oxygen with newborn infants.