Oxidative stress in asphyxiated term infants resuscitated with 100% oxygen

J Pediatr. 2003 Mar;142(3):240-6. doi: 10.1067/mpd.2003.91.


Objective: To test the hypothesis that resuscitation of asphyxiated infants with pure oxygen causes hyperoxemia and oxidative stress.Study design Asphyxiated term newborn infants (n = 106) were randomly resuscitated with room air (RAR = 51) or 100% oxygen (OxR = 55). The Apgar score, time of the first cry, and establishment of a sustained pattern of respiration were recorded. Assays performed included: blood gases; reduced glutathione (GSH) and oxidized glutathione (GSSG) in whole blood; glutathione-related enzyme activities; and superoxide dismutase activity (SOD) in erythrocytes.

Results: The RAR group needed less time of ventilation for resuscitation (5.3 +/- 1.5 vs 6.8 +/- 1.2 min; P <.05). Pure oxygen caused hyperoxemia (PO(2), 126.3 +/- 21.8 mm Hg) that did not occur with the use of room air (PO(2), 72.2 +/- 6.8 mm Hg). GSH was decreased and GSSG, the glutathione cycle enzymes, and SOD activities were increased in both asphyxiated groups. However, the 100% oxygen-resuscitated group showed significantly greater alterations that correlated positively with hyperoxemia.

Conclusions: Asphyxia causes oxidative stress in the perinatal period, and resuscitation with 100% oxygen causes hyperoxemia and increased oxidative stress. Because there are no advantages to resuscitation with 100% oxygen, room air may be preferred under certain circumstances for the resuscitation of asphyxiated neonates.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Apgar Score
  • Asphyxia Neonatorum / metabolism
  • Asphyxia Neonatorum / therapy*
  • Carbon Dioxide / blood
  • Double-Blind Method
  • Fetal Blood / chemistry
  • Glutathione / blood
  • Glutathione Disulfide / blood
  • Glutathione Reductase / blood
  • Humans
  • Infant, Newborn
  • Oxidative Stress*
  • Oxygen / blood
  • Oxygen Inhalation Therapy* / adverse effects
  • Resuscitation*
  • Superoxide Dismutase / blood


  • Carbon Dioxide
  • Superoxide Dismutase
  • Glutathione Reductase
  • Glutathione
  • Oxygen
  • Glutathione Disulfide