The Evidence Mounts Against Use of Pure Oxygen in Newborn Resuscitation

The hardest exposures to indict as health hazards are common ones. Few will worry too much if an obscure dietary practice or a chemical found in only a handful of water supplies is implicated in disease, but the sometimes justified charge that epidemiologists are the “Chicken Littles ” of biomedicine— repeatedly telling us that the sky is falling—usually emerges when the phenomenon labeled hazardous is familiar, routine, and ordinary. Such was the fate of smoking, whose risks took decades to become accepted, and it took quite some time too before the pediatric community as a whole was convinced that aspirin was a real cause of Reyes syndrome. The same can be said of oxygen, used for generations by physicians for a wide variety of therapeutic purposes. Anyone who doubts that oxygen is a popular element with the lay public should visit the oxygen bars now installed in many of our airports and shopping malls. In this issue of The Journal, the analysis of Spector et al1 of the venerable data of the National Collaborative Perinatal Project (NCPP) describes a slightly higher risk of cancer in children exposed to>3 minutes of oxygen in the delivery room than in children without oxygen exposure. From the perspective of the individual, the excess risk is quite small. The NCPP data suggest that a population of 10,000 unexposed children will have about 6 cancers by the age of 5, whereas 10,000 children exposed to>