Hemostatic disturbances are common in asphyxiated newborns after resuscitation. We compared platelet function in hypoxic newborn piglets reoxygenated with 21% or 100% oxygen. Piglets (1-3 d, 1.5-2.1 kg) were anesthetized and acutely instrumented for hemodynamic monitoring. After stabilization, normocapnic hypoxia was induced with an inspired oxygen concentration of 10 -15% for 2 h. Piglets were then resuscitated for 1 h with 21% or 100% oxygen, followed by 3 h with 21% oxygen. Platelet counts and collagen (2, 5, and 10 g/mL)-stimulated whole blood aggregation were studied before hypoxia and at 4 h of post-hypoxia/ reoxygenation. Platelet function was studied using transmission electron microscopy and by measuring plasma thromboxane B 2 (TxB 2 ) and matrix metalloproteinase (MMP)-2 and -9 levels. Control piglets were sham-operated without hypoxia/reoxygenation. The hypoxemic (PaO 2 33 mm Hg) piglets developed hypotension with metabolic acidosis (pH 7.02-7.05). Upon reoxygenation, piglets recovered and blood gases gradually normalized. At 4 h reoxygenation, platelet aggregation ex vivo was impaired as evidenced by a rightwarddownward shifting of the concentration-response curves. Electron microscopy showed features of platelet activation. Plasma MMP-9 but not MMP-2 activity significantly increased. Resuscitation with 100% but not 21% oxygen increased plasma TxB 2 levels. Platelet counts decreased after hypoxia/reoxygenation but were not different between groups during the experiment. Resuscitation of hypoxic newborn piglets caused platelet activation with significant deterioration of platelet aggregation ex vivo and increased plasma MMP-9 levels. High oxygen concentrations may aggravate the activation of prostaglandin-thromboxane mechanistic pathway. MMP-2 (constitutive isoform, 72 kD) and MMP-9 (inducible isoform, 92 kD) are zinc-dependent endopeptidases that play an important role in the regulation of platelet aggregation (6 -9). MMPs are activated by proteolysis and oxidants including the peroxynitrite anion (6,10). Increased plasma MMP-2 and -9 activity with platelet dysfunction was observed in an animal model of extracorporeal circulation with a high oxygen environment (11). Lemke et al. (12) recently reported a surge in plasma MMP-9 activity in the first day of postnatal life, which is consistent with a change from a low to a high oxygen environment. Interestingly, in neonatal models of asphyxia, resuscitation with 100% oxygen is associated with higher oxidative stress and MMP-2 activities in the heart and brain than those with 21% oxygen (13,14). However, there is little information on the activity of MMPs in plasma and its relationship to platelet aggregatory function in the reoxygenation of asphyxiated newborns.Asphyxiated infants are often resuscitated with 100% oxygen, and this is associated with increased oxidative stress up to 28 d after birth (15). In the midst of the debate between the use of 21% or 100% oxygen in the resuscitation of asphyxiated newborns, we designed this study to examin...