Oxygen - elixir of life or Trojan horse? Part 1: oxygen and neonatal resuscitation

General anesthesia, germ cells and the missing heritability of autism: an urgent need for research

Agents of general anesthesia (GA) are commonly employed in surgical, dental and diagnostic procedures to effectuate global suppression of the nervous system, but in addition to somatic targets, the subject's germ cells-from the embryonic primordial stage to the mature gametes-may likewise be exposed. Although GA is generally considered safe for most patients, evidence has accumulated that various compounds, in particular the synthetic volatile anesthetic gases (SVAGs) such as sevoflurane, can exert neurotoxic, genotoxic and epigenotoxic effects, with adverse consequences for cellular and genomic function in both somatic and germline cells. The purpose of this paper is to review the evidence demonstrating that GA, and in particular, SVAGs, may in some circumstances adversely impact the molecular program of germ cells, resulting in brain and behavioral pathology in the progeny born of the exposed cells. Further, we exhort the medical and scientific communities to undertake comprehensive experimental and epidemiological research programs to address this critical gap in risk assessment.

Newborn Resuscitation in Settings Without Access to Supplemental Oxygen

Low- and middle-income countries and resource-limited regions are major contributors to perinatal and infant mortality. Oxygen is widely used for resuscitation in high- and middle-income settings. However, oxygen supplementation is not available in resource-limited regions. Oxygen supplementation for resuscitation at birth has adverse effects in human/animal model studies. There has been a change with resultant recommendations for restrictive oxygen use in neonatal resuscitation. Neonatal resuscitation without supplemental oxygen decreases mortality and morbidities. Oxygen in resource-limited settings for neonatal resuscitation is ideal as a backup for selected resuscitations but should not be a limiting factor for implementing basic life-saving efforts.

Room air resuscitation and targeted oxygenation for infants at birth in the delivery room

The results of several clinical trials suggest that infants born depressed can be successfully resuscitated with room air. In 2010, the American Heart Association, American Academy of Pediatrics, Neonatal Resuscitation Program, and the International Liaison Committee published new guidelines to initiate the resuscitation of the term neonate with 21% oxygen. Although this recommendation cannot be extrapolated to the preterm neonate, the use of oxygen for resuscitation in this population can be used cautiously.

Oxygen saturation levels in the first 30 minutes of life

PURPOSE

To report a serendipitous finding from a larger investigation describing physiologic variability of healthy and sick pre- and full-term neonates transitioning to extrauterine life in whom the oxygen arterial saturations rose to 90% very quickly.

SUBJECTS

Thirty-four healthy pre- and full-term neonates and 40 sick pre- and full-term neonates.

DESIGN

Descriptive, comparative.

METHODS

Within the first 15-30 seconds of life, a pulse oximeter probe was placed on the dorsum of the neonate's foot. The signal was uploaded from the Hewlett Packard Viridia cardiopulmonary/oxygen saturation monitor to a data acquisition module at the bedside. Healthcare personnel performed their routine caregiving procedures for the neonate beginning transition to extrauterine life. They were at liberty to administer oxygen when they felt it was clinically necessary.

MAIN OUTCOME MEASURES

Oxygen saturation as measured by pulse oximetry.

PRINCIPAL RESULTS

Oxygen saturation values reached higher levels much faster for all groups of neonates than what has been previously reported in the literature.

CONCLUSIONS

In light of recent controversies regarding oxygen therapy, the practice of randomly administering oxygen to healthy infants at time of delivery should be examined.