Room Air Vs 100% Oxygen For Resuscitation Of Infants At Birth: A Systematic Review

Objective To evaluate the efficacy and safety of room air versus 100% oxygen for resuscitation of infants at birth.Method Electronic databases including Cochrane Library(2010, issue7), EMbase.com (1966～2010.7), MEDLINE(1966～2010.7), Chinese Biomedical Literature Database(1978～2010.7), Chinese Scientific Journal Full-text Database(1994～2010.7), Chinese Journal Full-text Database(1989～2010.7), and WanFang Database were searched. The randomization controlled trials or quasi-randomization controlled trials about room air versus 100% oxygen for resuscitation of infants at birth will be included regardless of allocation concealment and blinding. Based on the Handbook5.0.2 provided by Cochrane collaboration, two rsearchers extracted information of included literatures independently:the basic characteristic of included trails, baseline of two groups'patients; intervention study, outcome variables, lost of follow up and how to deal with it; methodological quality. Meta-analysis will be used in homogenous trials by RevMan5.0.1 and description analysis will be used in some trilas existing heterogeneity, according to the simple assessment approaches provided by the Cochrane Collaboration.Results Five studies were identified which enrolled a total of 1302 infants. In two studies allocation was randomised and the caregivers were blinded to intervention group. In the other three studies, allocation was quasi-randomised and the caregivers were not blinded. Pooled analysis of the four trials reporting effect on death showed a significant reduction in the rate of death in the group resuscitated with room air [RR 0.71,95% CI (0.54,0.94)]. There were no significant differences between the groups with respect to rates of grade 2 or 3 hypoxic ischaemic encephalopathy[RR=0.84; 95% CI(0.65,1.08)]. One of the four trials reported a statistically significant difference in 5 minute Apgar scores, favouring the group allocated to room air. One trial followed up a selected subgroup of survivors to 18～24 months. There were no significant differences in rates of adverse neurodevelopmental outcomes including cerebral palsy, and the same result for time to establish regular respirations, time to establish heart rate>100bpm, failure of resuscitation.Conclusion There is insufficient evidence at present on which to recommend a policy of using room air over 100% oxygen, or vice versa, for newborn resuscitation. A reduction in mortality has been seen in infants resuscitated with room air, and also Apgar score benefited. There is no statistical difference when it related to 18～24 months neurodevelopmental and Failure of resuscitation between room air and 100% oxygen. Due to the small number of identified studies and their methodologic limitations, we can not recommend room air over 100% oxygen, vice versa, and large number, multicenrtic RCTs are needed to comform its efficacy and safety.