What is the recommended oxygen concentration for the initial resuscitation of newborns at 35 weeks gestation or more?

The recommended oxygen concentration for the initial resuscitation of newborns at 35 weeks gestation or more is 21% oxygen, which is the same as room air. This approach aligns with current guidelines and evidence showing that for most infants who require resuscitation, starting with room air minimizes the risk of oxygen toxicity and allows for a more controlled and physiologically appropriate response to resuscitation needs.

Using room air helps to reduce the incidence of bronchopulmonary dysplasia and other complications associated with high concentrations of oxygen, such as oxidative stress. Newborns of this gestational age generally have developed sufficient lung capacity and pulmonary function, enabling them to initiate their own respiration effectively, provided they receive appropriate assistance when necessary.

Higher concentrations of oxygen, such as 30%, 40%, or 100%, are not recommended for initial resuscitation because they can increase the likelihood of hyperoxia and its associated risks. Thus, starting at 21% allows for a more balanced approach while ensuring that newborns receive sufficient oxygen to stabilize their condition during resuscitation.