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Room Air Resuscitation
Resuscitation with Room Air Instead of 100% Oxygen Prevents Oxidative Stress in Moderately Asphyxiated Term Neonates. Vento M, Asensi, M, Sastre J, et al. Pediatrics 2001;107(4):642-7.
Eligible term neonates with perinatal asphyxia were randomly resuscitated with either room air of 100% oxygen. The clinical parameters recorded were Apgar score at 1, 5, and 10 minutes, time to onset of first cry, and time to onset of sustained respiration. In addition, reduced and oxidized glutathione concentrations, and antioxidant enzyme activities (superoxide dismutase, catalase and glutathione peroxidase) were determined from blood from the umbilical artery at delivery, and in peripheral blood at 72 hours and at 4 weeks post natal age.
Results: The room air resusctiation (RAR) group needed significantly less time to first cry than the group resuscitated with 100% oxygen (1.2 +/- 0.6 minutes vs 1.7 +/- 0.5 minutes). Moreover, the RAR group needed less time undergoing ventilation to achieve a sustained respiratory pattern than the group resuscitated with pure oxygen (4.6 minutes +/- 0.7 minutes vs 7.5 +/- 1.8 minutes). The reduced-to-oxidized-glutathione ratio, which is an accurate index of oxidative stress, of the RAR group (53 +/-9) at 28 days post natal age showed no differences with the control (non-asphyxiated) group (50 +/- 12). However, the reduced-to-oxidized-glutathione ratio of the group resuscitated with 100% oxygen (15+/-5) was significantly lower revealing protracted oxidative stress. Furthermore, the activities of superoxide dismutase and catalase in erythrocytes were 69% and 78% higher, respectively, in the 100% oxygen group than in the control group at 28 days of postnatal age. There were no differences in antioxidant enzyme activities between the RAR group and the control group at this stage.
Comment. These data provide strong evidence that the practice of resuscitating asphyxiated babies with 100% oxygen produces enzyme changes consistent with long-term oxidative stress and, therefore, may be harmful. The issue of whether resuscitation with 100% oxygen increases oxidative brain injury and worsens neurodevelopmental outcome in these infants was not addressed by this study. These questions may be answerable using PET scans in the acute phase, or by looking at neurodevelopmental outcomes at 2 or 6 years of age. There appears to be no apparent disadvantage to using room air to ventilate asphyxiated term babies in the delivery room, as they seem to recover more quickly with room air resuscitation.