Oxygen saturations in premature infants at resuscitation. Where is the evidence?

Premature infants < 32 weeks’ gestation often require resuscitation during fetal to neonatal transition, which includes administration of supplemental oxygen. Hyperoxia is one of the important generators of reactive oxygen species (ROS) and excess ROS is kept in check by antioxidant defense mechanisms. Premature infants have reduced antioxidant defense mechanisms at birth and hence are at risk for toxic effects of oxygen [1]. Supplemental oxygen in premature infants contributes to development of bronchopulmonary dysplasia (BPD) [2], retinopathy of prematurity [3] and brain injury [4]. The awareness of oxygen toxicity in premature infants has led to strategies such as limiting oxygen exposure at birth, use of antioxidants and administering room air at neonatal resuscitation to reduce free radical formation and to optimize long term outcomes.