Pre-labor exposure to carbon monoxide: Should the neonate be treated with hyperbaric oxygenation?

A woman was admitted to hospital in the 39th week of gestation due to syncope, followed by nausea and headache. The patient's history revealed a 10-hour, unintentional exposure to carbon monoxide (CO), secondary to burning charcoal for indoor heating. Because of monitored fetal distress, a cesarean section was performed. The newborn had an Apgar score of 4, 9, and 10 at 1, 5, and 10 minutes postdelivery, respectively. The 1-minute Apgar was low due to lack of spontaneous breathing, reduced tonus, bluish coloration, and reduced response to pain. The neonate's carboxyhemoglobin level seven hours post-CO exposure was 22%, and arterial pH was 7.28. Neurological examination 30 minutes after delivery showed no pathology. The neonate was treated with 100% normobaric oxygen for 12 hours. We discuss the treatment options for fetal CO poisoning and specific considerations that had to be taken into account in the present case.