Air versus oxygen for resuscitation of infants at birth

Abstract

Characteristics of included studies [ordered by study ID] Methods Concealment of allocation: No-quasi-randomised by date of birth (even dates=room air, odd dates=100% oxygen) Blinding of intervention: No Completeness of followup: Yes for short-term outcomes-100% followup for in-hospital outcomes but No for outcomes at 28 days (86%) Blinding of outcome measurement: No Participants Single centre study. 84 neonates with apnoea and/or heart rate < 80 bpm and a birth weight > 999 g. Interventions Room air (n=42) or 100% oxygen (n=42) via intermittent positive pressure ventilation (IPPV) with ambu bag and mask at 60 bpm. Backup use of 100% O2 allowed for room air group, if baby remained cyanotic or bradycardic at 90 sec (all infants analysed on an intention to treat basis). Outcomes Death. Arterial blood gas status at 10 and 30 minutes of life. Neurological examination at 0-3, 4-7 and 28 days of life. Notes This study was designed in Oslo, Norway and performed in New Delhi, India. It served as a pilot study for a bigger study (Saugstad 1998). Risk of bias Bias Authors' judgement Support for judgement Allocation concealment? High risk C-Inadequate Ramji 1993 Methods Concealment of allocation: No-quasi-randomised by date of birth (even dates=room air, odd dates=100% oxygen) Blinding of intervention: No Completeness of followup: Yes. Blinding of outcome measurement: No Participants Multicentred (4 Indian units) study. 431* neonates weighing more than 1000g having a heart rate <100/ minute and/or apneic and unresponsive to stimulation. Excluded lethal anomalies, hydrops fetalis, congenital pulmonary or cardiac defects. Interventions Room air (n=210) or 100% oxygen (n=221) via intermittent positive pressure ventilation (IPPV) with infant resuscitation bag and mask at 60 bpm. Backup use of 100% O2 allowed for room air group, if baby remained cyanotic or bradycardic at 90 sec (all infants analysed on an intention to treat basis).

High or Low Oxygen Saturation and Severe Retinopathy of Prematurity: A Meta-analysis

“…Indeed, neonatal resuscitation with room air seems to be as effective as 100% oxygen and may even be associated with reduced mortality rates. 57,58 Regarding pulmonary outcomes, the authors of 2 early-oxygen studies reported a reduced risk of chronic lung disease with low oxygen saturations, 10,14 a finding that was confirmed by a cohort study on bronchopulmonary dysplasia. 59 …”

Predictors of Bronchopulmonary Dysplasia

“…In a Cochrane meta-analysis of studies comparing resuscitation with 100% oxygen to resuscitation with room air in term and near term infants, resuscitation performed with room air resulted in lower mortality than in those resuscitated with 100% oxygen (RR=0.71]). 70 However, among preterm infants the role of supplemental oxygen therapy in the delivery room is less clear. In a RCT of room air versus oxygen administration for the delivery room resuscitation of preterm infants less than 32 weeks gestation (ROAR study), there was no difference in the outcomes of BPD or death among infants treated with either room air, titrated oxygen therapy or those who received static 100% oxygen.…”

Effects of preterm birth and ventilation on glomerular capillary growth in the neonatal lamb kidney

“…In addition, the immature kidneys are abruptly exposed to high oxygen (O 2 ) concentrations relative to the intrauterine environment through ventilation and supplemental oxygen therapy (21–100% O 2 is utilised[9]), with arterial blood oxygen saturation rapidly increasing after birth [10]. These high O 2 concentrations are known to impact hypoxia inducible factor (HIF)-1α levels and subsequently downregulate the expression of vascular endothelial growth factor (VEGF) [11, 12] which is essential for glomerular capillary growth and development [13, 14].…”