Resuscitation of Asphyxic Newborn Infants with Room Air or 100% Oxygen

Abstract

To test the hypothesis that room air is superior to 100% oxygen when asphyxiated newborns are resuscitated, 84 neonates (birth weight > 999 g) with heart rate < 80 and/or apnea at birth were allocated to be resuscitated with either room air (n = 42) or 100% oxygen (n = 42). Serial, unblinded observations of heart rates at 1, 3, 5, and 10 min and Apgar scores at 1 min revealed no significant differences between the two groups. At 5 min, median (25th and 75th percentile) Apgar scores were higher in the room air than in the oxygen group [8 (7-9) versus 7 (6-8), p = 0.03]. After the initial resuscitation, arterial partial pressure of oxygen, pH, and base excess were comparable in the two groups. Assisted ventilation was necessary for 2.4 (1.5-3.4) min in the room air group and 3.0 (2.0-4.0) min in the oxygen group (p = 0.14). The median time to first breath was 1.5 (1.0-2.0) min in both the room air and oxygen groups (p = 0.59), and the time to first cry was 3.0 (2.0-4.0) min and 3.5 (2.5-5.5) min in the room air and oxygen groups, respectively (p = 0.19). Three neonates in the room air group and four in the oxygen group died in the neonatal period. At 28 d, 72 of the 77 surviving neonates were available for follow-up (36 in each group), and none had any neurologic sequelae.(ABSTRACT TRUNCATED AT 250 WORDS)

Near-Infrared Spectroscopy Measurements of Cerebral Oxygenation in Newborns during Immediate Postnatal Adaptation

“…4,5 While over the last decades, the main focus of concern regarding possible causes of impaired neurological outcome was on insufficient oxygenation during the perinatal period, there is, based on the work of Ola Saugstad, Maximo Vento and other researchers, increasing concern regarding shortand long-term damage to newborns exposed to high oxygen concentrations in the delivery room. [6][7][8][9][10][11][12][13] It is only recently that the noxious potential of excess oxygen exposure during the resuscitation of near-term or term infants immediately after birth has been recognized. 14,15 It has therefore been proposed to start neonatal resuscitation in the delivery room by administering a lower FiO 2 , a proposal which has been echoed by several international recommendations on neonatal resuscitation.…”

No evidence for superiority of air or oxygen for neonatal resuscitation: a meta-analysis

“…Excluding both the Bajaj et al 4 and Saugstad et al 8 studies, the RR for hypoxic/ischemic encephalopathy would be RR = 1.03 (95% CI = 0.81 to 1.32; P = 0.82; I-squared 0%) (n = 516 patients; oxygen = 263 and room air = 253-all derived from the same authors). 6,7 The risk of requiring a tracheal intubation was similar for the two treatment groups (RR 0.85; 95% CI = 0.69 to 1.05 [random effects model]; P = 0.12; I-squared = 9.5%) (Fig. 5).…”

“…The eight studies retained for analysis included 1,500 patients, 772 in the oxygen group and 728 in the air group. [4][5][6][7][8][9][10][11][12] The exact distribution per country cannot be given because 18 patients originally reported by Saugstad et al 8 were counted twice and need to be subtracted; nevertheless, as originally reported, the distribution would be: India = 1,148; Egypt = 121; Philippines = 26; Estonia = 26; Spain = 85; Denmark = 69; Norway = 2; United States = 41. The risk of bias assessment is given in Fig.…”

“…Four studies were quasi-randomized (allocation according to the date of birth [even vs odd]). 4,[6][7][8] One study mentioned that neonates for whom spontaneous circulation was never achieved were considered stillbirths and were excluded from the analysis. 8 For that study, deaths included in the analysis occurred only in non-European countries.…”

“…The expertise/training of the resuscitators was unspecified for four of the eight studies. [4][5][6]10 One study 8 excluded from the count of deaths those neonates for whom a spontaneous circulation was never achieved (true failed resuscitation). This ought to be considered as a major flaw.…”