Neonatology pp 242-249 | Cite as

Oxygen Toxicity

  • Giuseppe Buonocore
  • Rodolfo Bracci
  • Serafina Perrone
  • Maximo Vento


Although the use of oxygen in the care of newborns dates since the eighteenth century [1] and the toxic effects of oxygen had been mentioned already at the end of the 19th century [2], the first evidence of a relationship between oxygen toxicity and neonatal diseases emerged in the early 1950s when retinopathy was observed in premature infants breathing high concentrations of oxygen [3]. At about the same time, the red cells of newborns were demonstrated to have increased susceptibility to oxygen damage [4]. Great advances in our understanding of toxic effects of oxygen were made in the years that followed, when oxygen toxicity was recognized to be due to the development of reactive oxygen species (ROS). The main ROS are the superoxide anion (O 2 ), hydrogen peroxide (H2O2), lipid peroxide (LOOH), peroxyl radicals RO 2 · and the hydroxyl radical (OH·). Other important radicals are the highly reactive electron delocalized phenoxyl radical (C6H5O) and nitric oxide (NO) [4]. The term ROS includes free radicals, which are atoms or molecules with one or more unpaired electrons. A free radical can be defined as any molecule capable of independent existence with one or more unpaired electrons. In addition, ROS encompasses molecules that can be defined as free radicals (e.g., anion superoxide) and others that are oxidizing species, relative to molecular O2 but do not possess an unpaired electron (e.g., hydrogen peroxide) [5]. Free radicals may react with other radicals, the unpaired electrons forming a covalent bond. The resulting molecule may decompose other molecules into toxic products. Free radicals may react with non-radical molecules in free radical chain reactions, which are stopped by antioxidant molecules, enzymes or protein reactions. Superoxide anion [O 2 ] is the precursor of most ROS and a mediator in oxidative chain reactions. Dismutation of O 2 by superoxide dismutase SOD) produces H2O2 which in turn may be fully reduced to water by glutathione peroxidase (GSH-Px) and catalase (Cat) or partially reduced to hydroxyl radical [OH·]. The latter reaction is called the Fenton-Haber Weiss reaction and is catalyzed by reduced transition metals, particularly iron, but also copper and zinc [6]. There is no specific scavenger for this radical and, once released, OH· reacts with lipoproteins, cell membranes, lipids, proteins, DNA, amino acids and other molecules causing structural and functional damage to theses structures. Since the OH· is formed by the so called Fenton reaction which is dependent on non protein bound iron (NPBI), the conditions of intracellular or extracellular availability of NPBI is one of the most important source of ROS dependent tissue damage. Oxidative tissue damage may also be mediated by reactive nitroxide species [6]. The reaction product of NO and O 2 is the unstable molecule peroxynitrite (ONOO) which is regarded as highly reactive [6].


Reactive Oxygen Species Reactive Oxygen Species Production Preterm Infant Oxygen Toxicity Advanced Oxidation Protein Product 
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Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • Giuseppe Buonocore
    • 1
  • Rodolfo Bracci
  • Serafina Perrone
  • Maximo Vento
  1. 1.Department of Pediatrics, Obstetrics and Reproductive Medicine Division of NeonatologyUniversity of SienaSienaItaly

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