Oxygen therapy is an essential part of emergency neonatal care that can provide great benefit to neonates suffering from hypoxia (1). However, the use of oxygen therapy in neonates comes with risks. In the post-World War II era retinopathy of prematurity in premature infants was a leading cause of blindness in Europe and North America, with unmonitored oxygen therapy as the major risk factor (2). Some have argued that we are now in another epidemic of retinopathy of prematurity, occurring due to the rampant unmonitored oxygen therapy on premature infants in low and low-middle income countries (3). In this pragmatic review, we aim to evaluate the peer-reviewed literature of low and low-middle income countries to summarize the state of neonatal oxygen therapy, identify areas of needed quality improvement, and identify where further research is needed.