Air or 100% oxygen for asphyxiated babies? Time to decide

Both experimental and clinical studies have demonstrated that room air is as efficient as 100% oxygen for newborn resuscitation and improves short-term recovery. The recent meta-analysis by Davis and colleagues in the Lancet includes five studies from the past 10 years where asphyxiated infants were randomised or pseudo-randomised to be resuscitated in room air or in 100% oxygen. A significant reduction in mortality was seen when infants were resuscitated in room air compared to 100% oxygen. It is astonishing that a brief exposure of only a few minutes to 100% oxygen may be so toxic to the newborn infant; this finding, however, is supported by increasing evidence from experimental work emphasising that resuscitation in 100% oxygen may be associated with an aggravation of cellular injury when compared with resuscitation in air. It is imperative that these findings are reflected in the new newborn resuscitation guidelines and that further research continues in this area of neonatal medicine. Key areas include defining the best resuscitation practice for the preterm infant, designing adequate multicentre, randomised and blinded studies of term newborn resuscitation with adequate outcome data, and pursuing intense experimental research into the mechanisms and prevention of injury from oxygen free radicals.