[Which is better to resuscitate asphyxiated newborn infants: room air or pure oxygen?]

To find out optional resuscitation gas for asphyxiated newborn infants based on a systemic review of the published studies that compared the effects of resuscitation of asphyxiated newborn infants with room air or pure oxygen.

Inclusion criteria were randomized or pseudo-randomized studies of asphyxiated newborn infants resuscitated with room air or pure oxygen. The studies published between Jan. 1966 and June. 2005 were searched in PubMed/EMBASE/the Cochrane library databases. All identified studies that fulfilled our inclusion criteria were included. We did a systemic review and a meta-analysis of studies that compared parameters of efficacy, such as mortality, incidence of hypoxic ischemic encephalopathy (HIE) and the rate of resuscitation failure of newborn infants resuscitated with room air or pure oxygen.

Six identified studies were included, in which 988 infants were resuscitated with room air and 952 infants with pure oxygen. The mortality of asphyxiated newborn infants within the first week was 8.7% versus 13.4% in room air and pure oxygen groups, respectively, OR = 0.64, 95% CI 0.44 - 0.94. In 5 of the 6 studies, the mortality of term asphyxiated newborn infants was 5.9% versus 9.8% in room air and pure oxygen groups, OR = 0.59, 95% CI 0.40 - 0.87. The result for premature asphyxiated newborn infants was similar. In 4 studies, the incidence of moderate to severe neonatal HIE was 17.5% versus 20.1% in room air and pure oxygen groups, respectively, OR = 0.91, 95% CI 0.68 - 1.21. In 3 studies, the rate of resuscitation failure was 26.9% versus 29.1% in room air and pure oxygen groups, respectively, OR = 0.92, 95% CI 0.70 - 1.19.

The systemic review and the meta-analysis demonstrated that the mortality of asphyxiated newborn infants was significantly lower when resuscitated with room air, and no significant differences were found in the incidence of neonatal HIE and the rate of resuscitation failure. However, this conclusion should be used cautiously because of the limited number of studies.