The groundbreaking work of Dr Ola Saugstad and colleagues1,2 led to a reappraisal and more judicious use of oxygen in term infants. Of course, this led to questioning the appropriate fraction of inspired oxygen (Fio2) to use in the initial resuscitation of preterm infants. Preterm infants are particularly vulnerable to free radical–associated conditions and oxidative stress; the use of high oxygen load during resuscitation has been associated with increased oxidative stress, chronic lung disease, and prolonged need for oxygen and respiratory support.3 The 2015 International Liaison Committee on Resuscitation (ILCOR) Neonatal Resuscitation Guidelines recommend that for preterm infants <35 weeks’ gestation, resuscitation begins at a lower oxygen concentration (0.21–0.30) and not be higher than an initial oxygen concentration of 0.65.4
Trials data comparing resuscitation with lower or higher oxygen have yielded mixed results and do not fully support the ILCOR recommendation. The...
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