# Optimal Inspired Oxygen during Chest Compressions in Neonatal Resuscitation

> **NIH NIH R03** · STATE UNIVERSITY OF NEW YORK AT BUFFALO · 2021 · $79,750

## Abstract

ABSTRACT
Birth asphyxia is a global issue accounting for about 23% of approximately 2.5 million neonatal deaths
each year. These asphyxiated newly born infants require extensive resuscitation including chest
compressions (CC) in the delivery room, and suffer from high mortality and neurologic morbidity. The
optimal oxygen (O2) concentration during CC in an asphyxiated newborn is not known. The
recommendation by the Neonatal Resuscitation Program (NRP) to provide 100% inspired O2 during CC is
based on indirect evidence and expert opinion which has shown to cause oxidative injury. On the other
hand, ventilation with 21% O2 could lead to inadequate oxygenation resulting in delayed pulmonary
transition and elevated pulmonary vascular resistance (PVR) which may further extend the window of
hypoxic-ischemic injury. An intermediate O2 concentration (inspired O2 of 50%) could balance these two
competing processes and maintaining homeostasis after severe hypoxic-ischemic injury in cardiac arrest.
In this proposal we plan to determine the optimal inspired O2 (21%, 50% or 100%) during CC using a
randomized, masked study that optimizes oxygen delivery to the brain and heart leading to early return of
spontaneous circulation with minimal oxidative stress in perinatal lambs with perinatal asphyxia-induced
cardiac arrest.
To accomplish this 21 term fetal lambs will be asphyxiated by umbilical cord occlusion resulting in cardiac
arrest. Lambs will be randomized to 3 groups: Inspired oxygen of 21%, 50% and 100% during CC and rest
of the resuscitation steps will follow the NRP guidelines. Blood gases and hemodynamic parameters will
be continuously monitored. Lambs will be resuscitated for 20 minutes or till the ROSC is achieved,
whichever is earlier. At the end of 20 minutes, lambs will be euthanized and tissues will be collected for
oxidative stress markers. In this way, we can compare physiologic changes and the resultant oxidative
stress markers to better understand what may be happening during the resuscitation of an asphyxiated
human newborn.
Relevance to current practice in neonatal resuscitation:
Despite a lack of scientific evidence, supplemental oxygen has been used in neonatal resuscitation for
more than 200 years. There is a growing demand to resolve the controversy on oxygen therapy during
resuscitation of term asphyxiated infants in cardiac arrest. The studies proposed in this application are
likely to provide physiologic and biochemical data to aid in determining the optimal inspired oxygen during
CC and eventually refine neonatal resuscitation guidelines and may reduce the burden of birth
complications.

## Key facts

- **NIH application ID:** 10110341
- **Project number:** 1R03HD104062-01
- **Recipient organization:** STATE UNIVERSITY OF NEW YORK AT BUFFALO
- **Principal Investigator:** Munmun Rawat
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $79,750
- **Award type:** 1
- **Project period:** 2021-01-01 → 2022-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10110341

## Citation

> US National Institutes of Health, RePORTER application 10110341, Optimal Inspired Oxygen during Chest Compressions in Neonatal Resuscitation (1R03HD104062-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10110341. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*