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Oxidative stress in resuscitation and in ventilation of newborns

¹ Institute of Medical Paediatrics, Neonatal Intensive Care Unit, University of Messina, Messina, Italy. ² Dept of Cellular and Structural Biology, The University of Texas Health Science, Center at San Antonio, San Antonio, TX, USA.

CORRESPONDENCE: R. J. Reiter, Dept of Cellular and Structural Biology, University of Texas Health Science Center at San Antonio, Mail Code 7762, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA. E-mail: reiter{at}uthscsa.edu

Keywords: Bronchopulmonary dysplasia, modality of ventilation, newborn, oxidative stress, respiratory distress syndrome

Received: February 25, 2009
Accepted June 12, 2009

The lungs of newborns are especially prone to oxidative damage induced by both reactive oxygen and reactive nitrogen species. Yet, these infants are often 1) exposed to high oxygen concentrations, 2) have infections or inflammation, 3) have reduced antioxidant defense, and 4) have high free iron levels which enhance toxic radical generation. Oxidative stress has been postulated to be implicated in several newborn conditions with the phrase "oxygen radical diseases of neonatology" having been coined. There is, however, reason to believe that oxidative stress is increased more when resuscitation is performed with pure oxygen compared with ambient air and that the most effective ventilatory strategy is the avoidance of mechanical ventilation with the use of nasopharyngeal continuous positive airway pressure whenever possible. Multiple ventilation strategies have been attempted to reduce injury and improve outcomes in newborn infants. In this review, the authors summarise the scientific evidence concerning oxidative stress as it relates to resuscitation in the delivery room and to the various modalities of ventilation.