Oxygen is the first drug to be used at birth in the delivery room. It is
also the first drug used during care of the sick newborn. Oxygen is
hence made readily available and accessible, at all emergency points of
care, round the clock. It is well known that hypoxia is common in sick
newborns and an important predictor of outcome. In our zeal to deliver
oxygen, we seem to forget that like a drug it has to be delivered in a
The oxygen blender is a mixing device that permits
mixing of oxygen with compressed air, either from a wall outlet or from
a tank. Resuscitation guidelines recommend that the most appropriate and
accurate way to administer oxygen in the delivery room is by use of
blender . In preterm infants, it is recommended to initiate positive
pressure ventilation with 21-30% oxygen. In response to resuscitation,
oxygen needs to be titrated in a graded manner. Blender is required for
optimal oxygen delivery, weaning and use of continuous positive airway
pressure (CPAP). In absence of oxygen blender, the recommendations are
not met and the dose is ‘flow’ (liters/min) driven which leads to
variable and unrestricted oxygen delivery.
Unrestricted use of oxygen leads to hyperoxia,
release of oxygen free radicals and oxidative stress causing organ
dysfunction, disease and death . Of major concern is retinopathy of
prematurity (ROP), which is a leading cause of avoidable blindness in
preterm and term infants. WHO has identified ROP as a priority area
particularly in the middle income countries .
Blender is currently the ‘missing link’ in provision
of quality care for newborns. It is not considered as ‘essential’
equipment in government supplies, in National Neonatology Forum (NNF)
accreditation guidelines, or in neonatal intensive care unit (NICU)
equipment procurement list. It is not unusual to see a well equipped,
technology driven NICU without a blender. Blenders are practically
non-existent in majority of centers where child- birth occurs, and in
nurseries across India. There is a need to train and raise awareness
amongst doctors and nurses regarding the danger of treating infants with
100% oxygen. There is an urgent need for innovative blenders for
therapeutic use of oxygen. All sick newborn care units must place
priority in investing in air-oxygen blenders for regulating oxygen
delivery in order to provide rational, ethical and scientific neonatal
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2. Rogers S, Witz G, Anwar M, Hiatt M, Hegyi T.
Antioxidant capacity and oxygen radical diseases in the preterm newborn.
Arch Pediatr Adolesc Med. 2000;154:544-8.
3. Blencowe H, Moxon S, Gilbert C. Update on blindness due to
retinopathy of prematurity globally and in India. Indian Pediatr.