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 Journal
Review
Ramji
S, Rasaily R, Mishra PK, et al. Resuscitation of asphyxiated newborns
with room air or 100% oxygen at birth: A multicentric clinical
trial. Indian Pediatr 2003; 40: 510–517.
by
Michael E. Speer, MD
Introduction:
Recent studies suggest that resuscitation at birth of depressed
neonates using room air (RA) may be equal to or superior
to resuscitation with 100% oxygen (O). Additionally, resuscitation
with 100% oxygen has been associated with the excess release
of oxygen free radicals during posthypoxemia reoxygenation.
In India, two thirds of births occur either at home or in
facilities where oxygen is not available. Since birth asphyxia
accounts for 24.3% of neonatal deaths in that country, the
use of room air for resuscitation could potentially decrease
mortality due to this condition.
Methods:
This was a quasi-randomized trial carried out in 4 medical centers
in India between 1995 and 1997. Infants born on even numbered
days were resuscitated using room air; those born on odd
numbered days with 100% oxygen. Newborn infants >1000
grams birth weight that required assisted ventilation were
included in the study. Infants with lethal anomalies, hydrops,
and congenital lung or cyanotic heart defects were excluded.
Primary outcome was the Apgar score at 5 minutes. Secondary
outcomes included neonatal mortality and HIE within the first
7 days of life. Infants in the room air group who continued
to have bradycardia after 90 seconds of room air resuscitation
(treatment failures) were switched to 100% oxygen. Infants
resuscitated with 100% oxygen who had bradycardia at 90 seconds
of life also were noted.
Results:
At the 4 centers, 433 infants were eligible, two were excluded.
Of the enrolled infants, 210 were assigned to the RA group;
221 to the O group. The two groups were comparable in terms
of duration of labor, induction of labor, presence of fetal
distress, and/or meconium-stained liquor and type of delivery.
They were also comparable for birth weights and gestation.
At 1, 5, and 10 minutes, heart rates in both groups were
comparable. Median Apgar scores at 5 and 10 minutes were
the same in both groups. Similarly, the median time to first
breath was not different between groups. Median time to first
cry (2 vs. 3 minutes) and median duration of resuscitation
(2 vs. 3 minutes) were significantly shorter in the RA group.
The number of babies with stage II or stage III HIE during
first 7 days of life was significantly different between
the two treatment groups (17.1% RA; 24.9% O; p <0.05).
The two groups were not significantly different either in
the overall or asphyxia-related mortality (12.4% and 10%
RA vs. 18.1% and 13.6% O) or in the treatment failures observed
between the two groups (39% vs. 40.3%). The subset of preterm
infants was too small to analyze the effect of RA resuscitation.
Discussion:
This study complements the work reported by Sougstad1 and Vento2
in suggesting that neonatal resuscitation with room air is
an acceptable alternative to 100% oxygen in the term infant.
Additionally, a difference was observed in the severity of
HIE; this finding needs to be confirmed. Data do not yet
exist regarding the use of room air for the resuscitation
of the preterm neonate. Recent follow-up data3 at 18–24
months have demonstrated no significant differences in somatic
growth or neurologic handicap. Thus, in the absence of 100%
oxygen, room air should be used for bag-mask ventilation
in the depressed newborn.
References
- Saugstad OD, Rootwelt T, Aalen O. Resuscitation of asphyxiated newborn infants with room air or oxygen: an international controlled trial: the Resair 2 study. Pediatrics 1998;102(1):e1.
- Vento M, Asensi M, Sastre J, et al. Six years of experience with the use of room air for the resuscitation of asphyxiated newly born term infants. Biol
Neonate 2001;79(3-4):261-7. Review.
- Saugstad OD, Ramji S, Irani SF, et al. Resuscitation of newborn infants with 21% or 100% oxygen: follow-up at 18 to 24 months. Pediatrics 2003;112(2):296-300.
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