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 proper ‘dose’.

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 [1]. 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 [2]. 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 [3].

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 care.

1. Perlman JM, Wyllie J, Kattwinkel J, Wyckoff MH, Aziz K, Guinsburg R, et al. Part 7: Neonatal Resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Circulation. 2015;132:S204-41

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. 2016;53:S89-92.