We searched PubMed from 1966–04 using the terms “resuscitation”, “oxygen”, and “infant”; and the Cochrane Controlled Trials Register using “resuscitation” and “infant”. We searched Abstracts of the Society for Pediatric Research and the European Society for Paediatric Research from 1996–04, and found full-text articles on MEDLINE by searching for authors' names. Previous reviews were cross-referenced and personal files searched for additional references. No language restrictions were
ArticlesResuscitation of newborn infants with 100% oxygen or air: a systematic review and meta-analysis
Introduction
Rapid and complex physiological changes occur during birth. Usually, these changes are spontaneous and no intervention from health professionals is necessary. However, roughly 5–10% of newborn infants require some assistance to begin breathing in the first minutes after delivery.1 The aim of resuscitation is to prevent death and adverse long-term neurodevelopmental sequelae. International consensus statements on resuscitation of the newborn infant1, 2 state that adequate ventilation is the key to success, and that if assisted ventilation is required, 100% oxygen should be delivered by positive pressure ventilation. Others have noted3, 4 that this recommendation is based mainly on precedent rather than sound evidence.
Concerns have been raised about the potential adverse effects of 100% oxygen.5 Hyperoxia slows cerebral blood flow in term and preterm infants,6 and exposure to even brief periods of 100% oxygen at delivery causes long-term reductions in cerebral blood flow in newborn preterm infants.7 In addition, high concentrations of oxygen lead to generation of oxygen free radicals, which have a role in reperfusion injury after asphyxia.8, 9 Thus, air might be a more appropriate gas than 100% oxygen.10 We aimed to establish whether resuscitation with air reduced the occurrence of death or neurological disability in newborn infants compared with 100% oxygen.
Section snippets
Methods
We undertook a systematic review and meta-analysis using the methods and software of the Cochrane Collaboration. Three authors assessed each article according to the following criteria: masking of randomisation and intervention, completeness of follow-up, and masking of outcome assessment. Independently, these authors extracted data from every trial, then compared results and resolved differences. Four trials measured failure of resuscitation for both the 100% oxygen and air groups.13, 14, 15,
Results
Our initial search identified abstracts from about 350 potentially eligible clinical trials and 12 review articles; however most were rejected (eg, animal studies, commentaries, guidelines, or non-randomised human studies). Ten full-text articles were reviewed and five trials, totalling 1302 infants, fulfilled inclusion criteria (table 1).13, 14, 15, 16, 17 Allocation was quasi-random in three studies,13, 14, 17 which allocated babies born on even dates to resuscitation with air and those born
Discussion
One death would be prevented for every 20 babies resuscitated with air rather than 100% oxygen. No significant differences were recorded for outcomes of neurological disability. Resuscitation of adults and children is recorded as far back as biblical times,20, 21 but the use of 100% oxygen for this purpose is a recent notion.22 Providing supplemental oxygen to a patient who has had hypoxia seems logical. This biological plausibility, exemplified by the opinion that “oxygen is vital, not just
Search strategy and selection criteria
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Resuscitation of the newborn
2023, Anaesthesia and Intensive Care MedicineEffect of intrapartum oxygen on the rate of cesarean delivery: a meta-analysis
2021, American Journal of Obstetrics and Gynecology MFMOxygen saturation (SpO2) targeting for newborn infants at delivery: Are we reaching for an impossible unknown?
2021, Seminars in Fetal and Neonatal MedicineCitation Excerpt :In all infants, median (10th-90th percentiles) crSO2 was 41% [23–64] at 2 min, 68% (45–85) at 5 min, 79% (65–90) at 10 min, and 77% (63–89) at 15 min of age. In all neonates, median (10th-90th percentiles) cerebral fractional tissue oxygen extraction (cFTOE) was 33% [11–70] at 2 min, 21% [6–45] at 5 min, 15% [5–31] at 10 min, and 18% [7–34] at 15 min of age [78]. The same group noted that crSO2 varied based on the device manufactuer but later found no statistically significant differences based on device manufacturer [72–75].