Room air resuscitation versus oxygen resuscitation in the delivery room

The use of 100% oxygen for delivery room resuscitation is currently the recommended standard of the American Academy of Pediatrics and the Neonatal Resuscitation Program. However, there is mounting evidence from animal and human studies suggesting that resuscitation with room air (RA, 21% oxygen), including positive pressure ventilation with bag and face mask, may be as effective as that with 100% oxygen, and that the use of 100% oxygen may pose a risk of adverse physiologic sequelae. Resuscitation with RA has been demonstrated to result in faster recovery and improved neonatal mortality in comparison to 100% oxygen resuscitation. In addition, studies of normal oxygen saturation immediately after birth suggest delivery room personnel may be rushing to high saturation unnecessarily. The question for perinatal medical and nursing personnel involved in newborn resuscitation in the delivery room is whether the use of RA reduces the possible adverse effects of 100% oxygen, including delay in short-term stabilization, death, neurological disability, and possible secondary oxygen free radical injury. A systematic synopsis of both animal studies and human studies involving the advantages, disadvantages, possible risks, and short- and long-term effects of these 2 methods of resuscitation is presented.