Oxygen therapy for premature babies is a complex topic. Oxygen itself is not simply “good” or “bad,” but both too little and too much oxygen around the time of birth can affect the developing brain and may play a role in conditions like cerebral palsy. The key issue is how carefully oxygen levels are monitored and controlled, not whether oxygen is used at all.
What is cerebral palsy and why preemies are at higher risk
Cerebral palsy (CP) is a long term condition that affects movement, posture, and muscle control. It happens when a baby’s brain is injured or does not develop normally, most often before birth or in the first months of life. Premature birth is one of the strongest risk factors for CP because the brain and lungs are still very immature and more vulnerable to many kinds of injury.[1][6] Babies born very early, especially before 32 weeks of pregnancy, have a higher chance of problems like bleeding in the brain, white matter injury around the brain’s ventricles, infections, and breathing problems, all of which can raise the risk of CP.[1][3][7]
Why preemies need oxygen therapy
Most premature babies, especially those born very early or with very low birth weight, need help with breathing. Their lungs are often not ready to work on their own. They may receive:
• Extra oxygen through a small tube under the nose
• Continuous positive airway pressure (CPAP) to keep the lungs open
• A breathing machine (ventilator) that pushes air and oxygen into the lungs
Without enough oxygen, a baby’s brain and other organs can be damaged. A long or severe drop in oxygen can lead to a type of brain injury called hypoxic ischemic encephalopathy, or HIE, which is known to cause CP in some babies.[4][6] According to information summarized by the National Institute of Neurological Disorders and Stroke and other medical sources, a prolonged lack of oxygen to the brain can injure areas that control movement and posture, which can later show up as cerebral palsy.[4][6] You can read more about lack of oxygen and CP at sites such as https://www.sokolovelaw.com/birth-injuries/cerebral-palsy/causes/.
So in many cases oxygen support is life saving and helps to prevent brain injury. The danger is not that oxygen is used but how it is used and how closely the baby’s oxygen levels are watched.
Too little oxygen, too much oxygen, and the “sweet spot”
Doctors and nurses caring for preemies aim for a “sweet spot” where the baby gets enough oxygen to supply the brain and organs, but not so much that it causes new problems. Both extremes are harmful:
• Too little oxygen: Longer periods of low oxygen can injure the developing brain and contribute to CP, vision loss, and other disabilities.[4][5][6]
• Too much oxygen: Very high oxygen levels over time can damage delicate tissues. This has been clearly linked with eye disease in preemies (retinopathy of prematurity). Researchers also worry that unstable or very high oxygen levels might affect the brain’s blood flow and increase the risk of brain injury in some babies, although this relationship is more complex and not as direct as the link with eye damage.[3]
Modern neonatal intensive care units (NICUs) constantly monitor oxygen in the blood and often the brain. For example, near infrared spectroscopy (NIRS) devices can measure how much oxygen is reaching the brain tissue itself and help guide treatment.[3] A 2024 update of a Cochrane review found that using cerebral NIRS monitoring to guide care in very preterm infants did not clearly reduce major brain injury or major neurodevelopmental disability compared with usual monitoring, but it confirmed how central oxygen and blood flow are in NICU decision making.[3] You can read the abstract at https://pubmed.ncbi.nlm.nih.gov/41498617/.
Is oxygen therapy itself tied to cerebral palsy?
Based on current evidence, oxygen therapy in itself is not viewed as a simple, direct cause of cerebral palsy. The relationship is more about overall illness severity and how well oxygen levels are controlled.
Several points help explain this:
1. Prematurity and illness are the main drivers
Babies who are extremely premature or very sick often need more oxygen and more breathing support. The same babies also have higher risk of brain bleeding, infections, low blood pressure, and white matter injury, all of which are linked with CP.[1][3][7] So “more oxygen therapy” often just signals a baby who was sicker to begin with, rather than oxygen alone being the cause. Research on extremely preterm infants shows that conditions like severe bronchopulmonary dysplasia (a chronic lung disease of prematurity that usually requires prolonged oxygen and ventilation), serious infections, high grade intraventricular hemorrhage, and periventricular leukomalacia are all associated with a higher chance of cerebral palsy.[1] An overview of such risks can be found at resources like https://childrenscerebralpalsy.com/news/.
2. Lack of oxygen is a clearer risk than carefully monitored oxygen support
When oxygen supply to the baby’s brain is cut off or severely reduced, for example from birth complications, cord problems, or severe infections, this can directly injure brain tissue and may cause CP.[4][5][6] Premature detachment of the placenta, umbilical cord issues, or uterine rupture are examples of events that interrupt oxygen to the baby and increase CP risk.[6] Severe infections like meningitis or sepsis may also lower oxygen delivery to the brain and trigger inflammation, which can harm areas responsible for movement.[5] These events are different from standard, carefully controlled oxygen therapy, which aims to correct low oxygen, not cause it.
3. High oxygen problems are better recognized and managed today
Decades ago, very high oxygen levels were sometimes used in preemies without the kind of monitoring that is available now. This was later found to cause serious eye disease and possibly contribute to other complications. Modern guidelines use much tighter oxygen saturation targets and frequent adjustments, so the risk of oxygen related harm is lower than in the past. Large trials that compared lower versus higher oxygen targets focused mainly on survival and eye disease; they did not show a simple, strong signal that oxygen targets alone determined CP outcomes, which supports the idea that multiple factors are involved.
4. Brain monitoring tools focus on oxygen but show a complex picture
Newer tools, like NIRS for continuous brain oxygen monitoring and brain imaging methods that look at functional connections, show that preterm brains are very sensitive to changes in blood flow and oxygen. A study of preterm infants found that patterns of functional
