Resuscitation of Newborn Infants With 21% or 100% Oxygen: Follow-Up at 18 to 24 Months

Saugstad, Ola Didrik; Ramji, Siddarth; Irani, Simin F.; ELMeneza, Safaa; Hernandez, Emil A.; Vento, Máximo; Talvik, Tiina; Solberg, Rønnaug; Rootwelt, Terje; Aalen, Odd O.

doi:10.1542/peds.112.2.296

Cited by 136 publications

(76 citation statements)

References 12 publications

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“…A trend towards a onethird reduction in the incidence of neurological abnormalities (cerebral palsy/developmental delay) at 20 months in the Resair 2 study raises serious concerns on the use of room air. 12 The large number of patients lost to follow-up in this study, however, makes these results difficult to interpret. The percentage of patients lost to follow-up was similar across the two treatment groups but twice as high as the percentage of patients suffering from a neurological abnormality.…”

Section: Discussionmentioning

confidence: 77%

“…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.…”

Section: Resultsmentioning

confidence: 99%

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

Guay

Lachapelle

2011

Can J Anesth/J Can Anesth

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Purpose The aim of this meta-analysis was to re-evaluate the evidence in favour of oxygen or room air as the initial gas mixture for neonatal resuscitation in terms of the following outcomes: death, hypoxic/ischemic encephalopathy, need for tracheal intubation, and APGAR score-Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration-at five minutes. Methods A search with no language restriction for all available controlled clinical trials (CCT) was conducted in PUBMED, Cochrane Central Register of Controlled Trials, and EMBASE. Data were extracted independently by the two investigators. Results Eight CCTs were retained for analysis. They included 1,500 patients, 772 in the oxygen group and 728 in the air group. The evidence is based mainly on quasirandomized studies (1,311/1,500) with unblinded resuscitators (1,421/1,500). The expertise/training of the resuscitators was unspecified for four of the eight studies. The risk ratio (RR) for death was 1.35 (95% confidence intervals [CI] = 0.97 to 1.88; P = 0.08; I-squared 0%). The RR for hypoxic/ischemic encephalopathy was 1.03 (95% CI = 0.86 to 1.23; P = 0.74; I-squared 0%). The RR for requiring a tracheal intubation was 0.85 (95% CI = 0.69 to 1.05 [random effects model]; P = 0.12; I-squared = 9.51%). Conclusions The literature is insufficient to make any statement regarding the superiority of oxygen or room air as the initial gas mixture for neonatal resuscitation. RésuméObjectif L'objectif de cette me´ta-analyse e´tait de re´e´valuer les donne´es probantes soutenant la supe´riorited e l'oxyge`ne ou de l'air ambiant en tant que me´lange gazeux initial pour la re´animation ne´onatale en termes des crite`res suivants : de´ce`s, ence´phalopathie hypoxique / ische´mique, besoin d'intubation trache´ale et score APGAR -Apparence (couleur de la peau), Pouls (fre´quence cardiaque), Grimace (irritabilite´re´flexe), Activite´(tonus musculaire) et Respiration -a`cinq minutes.

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Section: Discussionmentioning

confidence: 77%

Section: Resultsmentioning

confidence: 99%

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

Guay

Lachapelle

2011

Can J Anesth/J Can Anesth

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“…Five years later, we published a follow-up study of a subset of the Resair 2 babies, showing that neurodevelopmental outcomes at 18 to 24 months of age were not different in surviving babies between the groups. 19 Subsequent experimental studies and clinical studies by Max Vento and his group and others have been extremely important, as these studies presented evidence that it is actually harmful to resuscitate newborn babies with 100% oxygen. [20][21][22][23][24][25][26] The Resair 2 study was criticized mainly for two reasons.…”

Section: Discovery Through a Failurementioning

confidence: 99%

Why are we still using oxygen to resuscitate term infants?

Saugstad

2010

J Perinatol

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This article summarizes the historical background for the use of oxygen during newborn resuscitation and describes some of the research and the process of changing the previous practice from a high-to a low-oxygen approach. Findings of a recent Cochrane review suggest that more than 100 000 newborn lives might be saved globally each year by changing from 100 to 21% oxygen for newborn resuscitation. This estimate represents one of the largest yields for a simple therapeutic approach to decrease neonatal mortality in the history of pediatric research. Available data also suggest that, for the very low birth weight infant, use of the low-oxygen approach should be considered with the understanding that some of the smallest and sickest preterm neonates will need some level of oxygen supplementation during the first minutes of postnatal life. As more data are needed for the very preterm population, creation of strict guidelines for these infants would be premature at present. However, it can be stated that term and late preterm infants in need of resuscitation should, in general, be started on 21% oxygen, and if resuscitation is not started with 21% oxygen, a blender should be available, enabling the administration of the lowest FiO 2 possible to keep heart rate and SaO 2 within the target range. For extremely low birth weight infants, initial FiO 2 could be between 0.21 and 0.30 and adjusted according to the response in SaO 2 and heart rate.

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“…High F IO 2 may prolong the time to spontaneous crying and breathing, increase oxygen consumption, decrease minute ventilation, cause atelectasis, or alter cerebral circulation (decrease cerebral blood flow). [9][10][11][12][13][14][15][16][17] By contrast, too low an F IO 2 can cause persistent pulmonary hypertension of the newborn, hypoxic brain injury, multisystem organ dysfunction, and is more likely to keep the ductus arteriosus open.…”

Section: Introductionmentioning

confidence: 99%

Resuscitation in the Delivery Room: Lung Protection From the First Breath

Wiswell

2011

Respir Care

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SummaryResuscitation of newborn infants occurs in approximately 10% of the more than 100 million infants born annually worldwide. The techniques used during resuscitation, such as positive-pressure ventilation and supplemental oxygen, may revive many infants, but have the potential to harm their lungs. In recent years increasing attention has been applied to providing lung protection from the first breath. This paper reviews the currently available medical evidence concerning modifying aspects of delivery room management that are thought to mitigate lung injury. These include: F IO 2 < 1.0; early use of continuous positive airway pressure (CPAP) and PEEP; optimizing pressure and/or volume during ventilation; sustained inflations; need for and timing of surfactant therapy; and airway management of meconium-stained amniotic fluid. Although the evidence against 100% oxygen use is of low quality, it has been enough to alter the recommendations for oxygen use in the delivery room. It is suggested (not mandated) to use room air initially when resuscitating a termgestation infant, and to use F IO 2 < 1.0 in premature infants, with F IO 2 adjustments depending on oximetry values. Recent studies have not indicated better outcomes in premature infants in whom CPAP or PEEP is applied in the delivery room. Optimal peak ventilatory pressure and tidal volume have yet to be delineated. Although an intriguing therapy, sustained inflations have not been shown to markedly improve outcomes. Prophylactic use of surfactant in small, premature infants remains the accepted standard. Immediate placement on CPAP after surfactant instillation has yet to demonstrate clear-cut advantages. Finally, intrapartum oropharyngeal and nasopharyngeal suctioning of meconium-stained amniotic fluid does not improve outcomes in meconium-stained infants. Moreover, routine intubation and intratracheal suctioning of apparently vigorous meconiumstained infants do not improve outcomes. In summary, although multiple therapies are touted as protecting the lungs in the delivery room "from the first breath," to date there are scant supportive data.

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Resuscitation of Newborn Infants With 21% or 100% Oxygen: Follow-Up at 18 to 24 Months

Cited by 136 publications

References 12 publications

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

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

Why are we still using oxygen to resuscitate term infants?

Resuscitation in the Delivery Room: Lung Protection From the First Breath

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