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Room Air Resuscitation Outcomes
Resuscitation of Newborn Infants With 21% or 100% Oxygen: Follow-Up at 18 to 24 Months. Saugstad OD, Ramji S, Irani SF, et al. PEDIATRICS (August 2003); 112;296-300.
Objective. To follow-up children who had been resuscitated at birth with either 21% or 100% oxygen (O2).
Methods. A multicenter study with 10 participating centers recruited 609 infants to the Resair 2 study where resuscitation was performed with either 21% or 100% O2. A follow-up between ages 18 and 24 months was performed. However, during follow-up registration, it was found that 18 infants had been enrolled twice in the original Resair 2 study with different registration numbers, leaving 591 enrolled in the Resair 2 study and 410 enrolled in the 7 centers participating in the follow-up. Of these 410 infants, 79 died (76 in the neonatal and 3 in the postneonatal period). Furthermore, for 8 infants informed consent was not obtained, leaving 323 eligible for follow-up. Of these, 213 infants (66%) were followed-up: 91 (62%) had been resuscitated with 21% O2, and 122 (69%) with 100% O2. At a median age of 22 and 20 months (not significant) in the 21% and 100% groups, respectively, a simple questionnaire was filled out and neurologic assessment was performed in addition to measuring anthropometric data.
Results. There were no significant differences in weight, height, or head circumference between the 2 groups. Cerebral palsy developed in 10% and 7%, respectively, in the 2 groups (not significant). In total, 11 cases (12%) in the 21% versus 11 cases (9%) in the 100% O2 group (odds ratio: 1.39, 95% confidence interval: 0.57–3.36) developed cerebral palsy and/or mental or other delay. Furthermore, it was concluded that 14 (15%) in the 21% group and 12 (10%) in the 100% group were not normal (odds ratio: 1.67, 95% confidence interval: 0.73–3.80).
Conclusions. There were no significant differences in somatic growth or neurologic handicap at an age of 18 to 24 months in infants resuscitated with either 21% or 100% O2 at birth. Based on these data, resuscitation with ambient air seems to be safe, at least in most cases. More studies are needed to settle this issue.
Comment. Not surprisingly, they were not able to demonstrate any significant differences in growth or long-term neurological outcomes between babies resuscitated at birth with room air or 100% oxygen. Room air resuscitation does appear to offer some acute advantages and be at least as safe as resuscitation with 100% oxygen (see 2-024 and 4-013). Since we now have the ability to monitor the baby’s oxygen saturation after delivery by pulse oximetry, what we should be looking at is the possibility of giving “appropriate” oxygen supplementation during resuscitation. Then the question to study will be whether we should start with room air and work up, or start at 100% and wean down?? In any case, it appears that the NRP guideline that requires resuscitation with 100% oxygen is out of date and should be changed. ABK
Date: 19 Aug 2003
Time: 14:55:53
A subject that could change the results of this study is that the chosen
population is the one of smaller risk of oxidative damage (term infants), a
focused study in preterms could show improvements in the outcome.
UserName: Juan Villagran
Institution: Hospital Sotero del Rio, Chile
telephone: +56-2-2862346
email: villagran_cl@yahoo.com
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