Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta-analysis

Davis, Peter G; Tan, Anton; O'Donnell, Barry; Schulze, Andreas

doi:10.1016/s0140-6736(04)17189-4

Cited by 352 publications

(190 citation statements)

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“…In most of the babies this transition is smooth; however 5-10% needs some assistance in breathing, while 1% requires extensive resuscitation [2,3]. The indications and timing of supplemental oxygen therapy to assist the newborn in this transition has been a matter of debate [4][5][6][7][8][9]. The 2010 ILCOR recommendations state that resuscitation can be initiated with room air or blended oxygen but it should be guided by measurement of oxygen saturation using pulse oximetry and the target saturation should fall in the interquartile range of preductal saturations measured in healthy term babies following vaginal birth at sea level [2].…”

Section: Introductionmentioning

confidence: 99%

Oxygen Saturation Profile in Healthy Term Neonates in the Immediate Post Natal Period

Tiwari

2013

Int J Clin Pediatr

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Background: A neonate undergoes major physiologic changes during transition from intrauterine to extrauterine period. The percentage saturation of hemoglobin takes about 10 minutes to reach a level of more than 90%. This fact is to be borne in mind while resuscitating a newborn with oxygen to avoid its toxicity. It is still unclear whether the oxygen saturation profile could be affected by racial/ethnic variation, birth weight, sex, APGAR score or maternal factors (age, hemoglobin, type of labor) in term healthy babies. This study aimed: 1) To note the time taken for SpO 2 to reach a value of 90%; 2) To note the time taken for preductal and post ductal SpO 2 to equalize; 3) To look for the association between SpO 2 and various infant and maternal factors.

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Section: Introductionmentioning

confidence: 99%

Oxygen Saturation Profile in Healthy Term Neonates in the Immediate Post Natal Period

Tiwari

2013

Int J Clin Pediatr

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“…[31][32][33][34] In the view of the available data, all these papers have come to similar conclusions: 21% is as efficient as 100% oxygen in restoring heart rate and spontaneous ventilation in depressed newborn infants. Further, all of the meta-analyses and systematic reviews conclude that neonatal mortality is significantly reduced in those resuscitated with 21% compared with neonates resuscitated with 100% oxygen.…”

Section: Discovery Through a Failurementioning

confidence: 79%

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%

“…Interestingly, a group of independent authors, using the aforementioned data, published meta-analyses in 2 separate reports published within months of each other and drew opposite conclusions. 16,17 In their initial publication, a Cochrane Systematic Review, 16 they concluded that the evidence was insufficient to recommend room air over 100% oxygen. Several months later, using the same data and analytical methods, they concluded that room air should initially be used for resuscitating term and near-term infants, with oxygen as a backup.…”

Section: Introductionmentioning

confidence: 99%

“…Several months later, using the same data and analytical methods, they concluded that room air should initially be used for resuscitating term and near-term infants, with oxygen as a backup. 17 Despite the limitations of the 6 investigations, the International Liaison Committee on Resuscitation recently revised its recommendations concerning the use of oxygen: "In term infants receiving resuscitation at birth with positive-pressure ventilation, it is best to begin with air rather than 100% oxygen. If, despite effective ventilation, there is no increase in heart rate, or if oxygenation (guided by oximetry) remains unacceptable, use of a higher concentration of oxygen should be considered."…”

Section: Introductionmentioning

confidence: 99%

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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 100% oxygen or air: a systematic review and meta-analysis

Cited by 352 publications

References 24 publications

Oxygen Saturation Profile in Healthy Term Neonates in the Immediate Post Natal Period

Oxygen Saturation Profile in Healthy Term Neonates in the Immediate Post Natal Period

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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