The aim of this study was to investigate whether reoxygenation with 21% O 2 rather than 100% O 2 results in reduced hydrogen peroxide (H 2 O 2 ) concentrations in neutrophils (PMN). Piglets (2-4 d old) exposed to severe hypoxia (inspired fraction of oxygen, 0.08) were randomized to resuscitation with 21 (n ϭ 13) or 100% O 2 (n ϭ 12). Five animals served as controls. H 2 O 2 concentrations in PMN in terms of rhodamine 123 (Rho 123) fluorescence intensity from arterial and superior sagittal sinus blood were quantified by flow cytometry. Laser Doppler flowmetry (LDF) was used to assess cortical blood perfusion. During hypoxia, Rho 123 increased in arterial PMN in both study groups by 15 and 32%, respectively (p Ͻ 0.05). In cerebral venous PMN, the increase was less dominant (p ϭ 0.06). Reoxygenation with 100 or 21% O 2 had no different effect on Rho 123 in arterial PMN. In cerebral venous PMN, Rho 123 was approximately 40% higher after 60 min and 30% higher after 120 min compared with corresponding data in the 21% O 2 group (p Ͻ 0.05), which were close to baseline levels. Further, O 2 treatment in both groups induced PMN accumulation in arterial blood (p Ͻ 0.05). Laser Doppler flowmetry signals increased during transient hypoxia (p Ͻ 0.0001 compared with baseline) and were normalized after reoxygenation in both study groups. The primary release of products of the sequential reduction of oxygen, superoxide radical (O 2 -) and H 2 O 2 , and the secondary production of hydroxyl radical (HO -) constitute the molecular mechanism of oxygen toxicity. Any system producing O 2 -will, as a result of the dismutase reaction, also produce H 2 O 2 . Although stable, the damaging redox properties of H 2 O 2 and its ability to form highly reactive free radicals in the presence of transition metal ions have caused the body to form defenses against it. The role of oxygen toxicity in the development of perinatal hypoxic-ischemic encephalopathy is still a matter of debate. The principal hypothesis put forward to explain this process is the oxygen free radical theory (1, 2).Stimulation of PMN during hypoxia-reoxygenation may increase the concentration of reactive oxygen species (3) in these cells. To date, the production of H 2 O 2 in PMN during hypoxia and resuscitation with pure or air-mixed O 2 has not been studied in detail. Reoxygenation is necessary to prevent further injury to neuronal tissue, but the renewed availability of O 2 to previously hypoxic brain tissue may also have detrimental effects both with respect to the microcirculation and to the parenchyma of the brain. The production of reactive oxygen metabolites may be proportional to PaO 2 , and the oxygen tension achieved during reactive hyperemia and reoxygenation with O 2 concentrations higher than 21% may generate a correspondingly higher burst of these metabolites. However, we