The Lancet Global Health Oxygen Commission calls for universal access to pulse oximetry and medical oxygen in all health facilities delivering and caring for babies.

STATEMENT: International Neonatal Nurses Day, 15 August 2025.

The Lancet Global Health Oxygen Commission calls for universal access to pulse oximetry and medical oxygen in all health facilities delivering and caring for babies. Pulse oximetry and medical oxygen are essential for the treatment of small and sick newborns, and should be consistently available in every newborn unit and labor ward, where they can also aid in safe childbirth, the prevention of stillbirth, and the management of babies with congenital conditions. In February 2025, The Lancet Global Health Commission on Medical Oxygen Security published the first global estimates of the wide gaps in access to pulse oximetry and medical oxygen for several patient populations, including newborns.

Around 364 million people need oxygen for acute medical and surgical conditions annually, including 5·4 million neonates with acute hypoxemia. This includes 3.2 million preterm babies, 1 million with sepsis and other infections, 700,000 with pneumonia, and 500,000 with encephalopathy. The Commission estimated the annual quantity of oxygen needed to meet the need for neonates at 16.8 million cubic metres.(1)

Alarmingly, the Commission found that many newborns with an acute need for pulse oximetry and medical oxygen were not getting it, with the widest gaps in smaller, government hospitals in low- and middle-income countries (LMICs).

Across LMICs, pulse oximetry use was extremely low in neonatal wards (6%) compared to adult wards (43%), emergency departments (70%), and operating theaters (91%). Oximeters, when available, were often poor quality, did not have batteries, were faulty or locked away, or did not have appropriately sized probes for neonatal care. Oxygen provision to neonates with hypoxemia tended to be higher (84%), but almost 1 in 6 neonates with an acute need for oxygen are not receiving it.(2)

Further, the disparity between pulse oximeter and oxygen use among neonates suggests that oxygen is being provided without pulse oximetry assessment or monitoring, presenting a major risk to newborns, as unregulated oxygen can damage developing eyes (i.e., retinopathy of prematurity) and lungs (i.e., bronchopulmonary dysplasia) in preterm infants. This issue is particularly concerning across Africa, where an epidemic of retinopathy of prematurity is emerging due to unrestricted oxygen use in preterm neonates.

The Commission concluded that increasing access to access to safe, effective, and efficient pulse oximetry and medical oxygen use could help countries reduce the 2.3 million annual neonatal deaths and achieve the Sustainable Development Goal for newborn survival (SDG 3.2) by 2030.(3)

Seventy-eight percent of neonatal deaths are from conditions where timely and adequate access to medical oxygen can make a difference (e.g., preterm birth, birth asphyxia, sepsis, pneumonia, and sepsis).

Accordingly, the Commission calls on governments to update all clinical guidelines, essential medicines and medical device lists, and related health policies to include pulse oximetry and medical oxygen, with a special focus on accelerating the use of pulse oximetry as routine assessment tool in primary, secondary, and tertiary healthcare facilities for newborns. Pulse oximetry and oxygen services must be included in national universal health coverage schemes. Inability to pay should never be a barrier to access medical oxygen, especially for families with a sick newborn.

Further, pulse oximetry and oxygen training should be included in preservice medical, nursing, and allied health curricula and in-service training for emergency obstetric and newborn care. The Commission also points out the substantial opportunities to increase the cost-efficiency of government investments through improvements in clinical management practices.

For example, a clinical quality improvement project in India reduced oxygen consumption in a neonatal unit by more than 50%, and the proportion of the running budget of the facility dedicated to oxygen from 79% to 38%.

The Commission also recommends that global health agencies with a mandate for newborn survival, including the World Health Organization (WHO) and UNICEF, update all relevant policies and guidelines to strengthen pulse oximetry and medical oxygen use.(4) The Commission found major gaps in several WHO and UNICEF guidelines, and has called for the routine use of pulse oximetry on sick children presenting to primary healthcare facilities, based on evidence that current WHO guidelines fail to identify ~70% of hypoxemic pneumonia cases and ~75% of children who eventually die.(5)

While the Commission applauds the global coverage target of at least one hospital providing CPAP and safe oxygen administration for sick newborns in 80% of districts in every country, there are no references to pulse oximetry in the Every Woman, Every Newborn, Everywhere (EWENE) targets or critical interventions. Pulse oximetry and medical oxygen are not included on the 13 priority maternal and newborn health commodities highlighted by the UN and there are no references to either in the Global Strategy for Women’s, Children’s, and Adolescent Health (2016-2030). We call on the EWENE partners to address this glaring omission.

The Commission has highlighted CPAP as one of 20 priority areas for innovation and encourages global health organizations including the Global Oxygen Alliance (GO₂AL) to continue to support greater investments in innovations, including CPAP and the other products and initiatives highlighted.(6) The Commission also acknowledges the potential lifesaving impact of pulse oximetry and medical oxygen during labor and delivery to protect the health of the mother, to prevent stillbirth, and to identify and manage congenital conditions. This is an area where further research in LMICs is urgently needed to inform policy and practice and guide new investments. For the full list of 52 recommendations, please refer to Panel 18 in the Commission report.

Endnotes

1.See Table 2 in the Commission report: Estimated number of patients needing oxygen for acute medical conditions globally and minimum volume of oxygen required to meet need, 2021.

2. See Figure 7 in the Commission report: Pulse oximetry use in (A) and oxygen provision to patients with hypoxaemia (B) in health facilities in low-income and middle-income countries, by ward area and facility level.

3. SDG 3.2 requires every country to reduce newborn deaths to at least 12 for every 1,000 babies born by 2030.

4. The Integrated Management of Childhood Illness: Management of a Sick Young Infant Aged up to 2 Months (WHO, UNICEF, 2019), the Early Essential Newborn Care: Clinical Practice Pocket Guide (WHO, and the Integrated Management of Pregnancy and Childbirth: Managing Complications in Pregnancy and Childbirth (WHO, UNICEF, 2017). See Figure 9 in the Commission report: Inclusion of pulse oximetry and oxygen within key clinical guidelines.

5. See King, C et al. The Lancet Global Health Commission on Medical Oxygen Security: paving the way for quality pulse oximetry and oxygen access for all children, Pediatric Pulmonology, in press.

6. See Table 4 in the Commission report: Priority areas for medical oxygen-related innovation.