The introduction of oxygen therapy was in many ways a panacea for clinicians caring for preterm infants in the early 20th century. These pediatricians (the term “neonatologist” was not coined until decades later) began to use oxygen supplementation to support preterm infants and achieved previously unthinkable survival rates. In 1934, Julius Hess, who was widely credited with developing the first incubator for oxygen administration, reported the survival of 4 extremely low birth weight (<1000 g) infants via use of his eponymous incubator, which provided ∼40% to 50% oxygen concentration. Within a decade, effective delivery of high oxygen concentration was widespread among NICUs, and survival rates climbed. But simultaneously, so did the incidence of retinopathy of prematurity (ROP), which was then called retrolental fibroplasia. In 1951, oxygen toxicity was identified as the cause of ROP. The response from pediatric providers was both swift and tragic; oxygen concentrations were decreased, and ROP rates declined, but mortality increased. It has been estimated that >16 infants died of hypoxemia for each case of blindness that was prevented. As a result, research efforts in neonatal care have begun to shift toward stewardship of this potentially lifesaving intervention by finding the optimal amount of oxygen delivery. Oxygen targeting has become more sophisticated because our understanding of oxygen toxicity has improved.

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Reference: Cantey JB and Hersh AL. Antibiotic Stewardship in the Neonatal Intensive Care Unit:Lessons From Oxygen.Pediatrics. 2019;143(3):e20183902