Intermittent Neonatal Hypoxemia: From Pathophysiology to Clinical Practice

Abstract

Neonatal intermittent hypoxemia (NIH) is a common condition in preterm infants and represents a key manifestation of immature respiratory control in the early postnatal period. It is characterized by recurrent episodes of decreased arterial oxygen saturation, most frequently observed in extremely preterm infants (<28 weeks of gestation). The pathogenesis of NIH is multifactorial and involves immaturity of the respiratory centre, altered peripheral chemoreceptor responsiveness, apnoea, and ventilation–perfusion mismatch. Recurrent hypoxia–reoxygenation cycles may induce oxidative stress and inflammatory responses, contributing to injury of multiple organ systems that lead to significant complications, including bronchopulmonary dysplasia and retinopathy of prematurity, which may have long-term consequences. Early recognition and appropriate management are essential to minimize adverse outcomes. Main management strategies include respiratory stimulation, non-invasive respiratory support, oxygen therapy and correction of underlying or contributing factors. This article reviews current knowledge on NIH pathophysiology, epidemiology, risk factors, clinical implications, and management.