Room air resuscitation of the depressed newborn: a systematic review and meta-analysis.

Understanding of the potential dangers of hyperoxia in the newborn is growing. Several studies have examined the use of room air for the resuscitation of newborns. To assess the effects of room air resuscitation versus 100% oxygen resuscitation on mortality at 1 week and 1 month in asphyxiated newborn infants. Systematic review and meta-analysis of seven randomized and quasi-randomised controlled trials comparing room air and 100% oxygen resuscitation of newborn infants. Compared to the 100% oxygen resuscitation group, neonates in the room air resuscitation group had a lower mortality both in the first week of life (odds ratio 0.70, 95% CI 0.50, 0.98) and at 1 month and beyond (odds ratio 0.63, 95% CI 0.42, 0.94). The incidence of severe hypoxic ischemic encephalopathy (Stage II and Stage III) was similar between the two groups. This meta-analysis supports the hypothesis that room air is superior to 100% oxygen as the initial choice for resuscitating clinically depressed newborns as it may result in a lower mortality rate. However, adequately powered studies of long-term neurodevelopmental outcomes are not yet available.