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.