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A clinician’s musings on oxygen: Too little or too much with life in the balance

Journal of Perinatology (2025)Cite this article

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Abstract

The most abundant element on Earth, oxygen (O2) is essential for all complex, eukaryotic life. Because under- (hypoxia) or overexposure (hyperoxia) to O2 can be detrimental, achieving the ideal balance is crucial for human survival. In this perspective, we discuss the fundamental role of hemoglobin in O2 transport and tissue oxygenation. We also discuss the role that O2. can play in oxidative stress, sometimes initiating inflammatory cascades in vulnerable individuals, such as those with deficiencies in antioxidant defenses or with immune dysregulation. Preterm newborns may be especially prone to such oxidative injury.

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Funding

This work was supported by the Prematurity Research Fund; the March of Dimes Prematurity Research Center at Stanford University; the Charles B. and Ann L. Johnson Research Fund; the Christopher Hess Research Fund; the Providence Foundation Research Fund; the Roberts Foundation Research Fund; the Stanford Maternal and Child Health Research Institute; and the Stanford Cardiovascular Institute.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatal & Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA

    David K. Stevenson, Ronald J. Wong, Jonathan D. Reiss, Ivana Marić & Anca M. Paşca

  2. Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Terence L. Ahern

Authors
  1. David K. Stevenson
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  2. Ronald J. Wong
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  3. Jonathan D. Reiss
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  4. Ivana Marić
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  5. Anca M. Paşca
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  6. Terence L. Ahern
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Contributions

DKS, RJW, JDR, IM, AMP and TLA drafted the initial manuscript, revised the manuscript, and approved the final version. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to David K. Stevenson.

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Stevenson, D.K., Wong, R.J., Reiss, J.D. et al. A clinician’s musings on oxygen: Too little or too much with life in the balance. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02398-8

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