A newborn baby's first breaths represent a crucial time in life, and when the baby is too small to breathe for itself, resuscitation with oxygen can be both a blessing and a curse.
Preterm infants often need help breathing at birth, but the use of high levels of oxygen can damage their immature lungs, leading to long-term complications such as bronchopulmonary dysplasia (BPD).
Clinicians face the challenge of balancing the risks of hypoxia (oxygen starvation) if too little oxygen is given, against the risks of hyperoxia (excess oxygen) and lung injury if too much is used.
The latest research from Hudson Institute of Medical Research, Monash Children's Hospital and the Department of Pediatrics at Monash University has shown that use of 100% oxygen at birth causes lung injury regardless of how the umbilical cord is managed, so high-oxygen resuscitation should be avoided.
Getting oxygen delivery to newborns just right
The head of Hudson Institute's Perinatal Transition Group, Professor Graeme Polglase, explained that this study, published in the journal Nature Pediatric Research, looked at whether physiological-based cord clamping (PBCC) could protect preterm lungs when resuscitated with 100% oxygen at birth, compared to immediate cord clamping (ICC).
"We found that while PBCC prevented an initial drop in oxygen levels and reduced hyperoxia, it did not reduce lung oxidative stress, inflammation, or injury compared to ICC." Prof Polglase said.
"These findings demonstrate that delaying cord clamping alone cannot counteract the harmful effects of prolonged high oxygen exposure."
Associate Professor Calum Roberts is a Neonatologist at Monash Children's Hospital who also heads the Neonatal Respiratory Research Group at Monash University's Department of Paediatrics. He says BPD, resulting from lung inflammation, is the most common respiratory complication of prematurity, which can have a life-long impact on lung health.
"Previous studies of oxygen use at birth have not included the use of modern cord-clamping strategies such as PBCC, so these findings are a crucial step forward in identifying the most effective and safe way for neonatal clinicians to provide initial oxygen support to preterm infants," A/Prof Roberts said.
Prolonged high oxygen should be avoided with vulnerable newborns
PhD candidate Emma Vandenberg worked with Prof Polglase and A/Prof Roberts on this research, which she believes will have important clinical implications.
"Our results emphasise that the use of prolonged high oxygen should be avoided during the resuscitation of preterm infants, regardless of the cord management strategy, to reduce the risk of long-term lung injury and associated complications." she said.
"Ultimately, this will help reduce lung injury in preterm babies, improving survival and long-term respiratory outcomes."
Prof Polglase agrees, saying that these findings fill an important knowledge gap and provide critical evidence to guide safer oxygen strategies in ongoing clinical trials and neonatal care.
