Achieving “normal oxygenation” in sick newborn infants requiring resuscitation is one of the most difficult and incompletely informed practices in neonatal care.

Suboptimal oxygenation, whether too little or too much, has profound repercussions, including death.

In the last two decades, clinicians have lost equipoise for the use of higher oxygen strategies due to concerns of hyperoxia but emerging evidence suggests that lower oxygen strategies may also be as detrimental, especially in infants with pulmonary pathologies such as those born at the cusp of viability.

Practice at the coalface using rapidly evolving recommendations has also uncovered continuing complexities in the quest to achieve optimum oxygenation during the first critical minutes of life.

There are adjustable factors, such as the practical impediments to acquiring knowledge, equipment and expertise as well as unadjustable factors, such as inherent infant pathology, that necessitates agile clinical manipulation to “first do no harm”.