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Neonatology. 2008 Jul 9;94(3):176-182. [Epub ahead of print]

Resuscitation of Newborn Infants with 21% or 100% Oxygen: An Updated

Systematic Review and Meta-Analysis.

Saugstad OD, Ramji S, Soll RF, Vento M.

Department of Paediatric Research, Rikshospitalet Medical Centre, University

of Oslo, Oslo, Norway.

Background: The issue of whether 21% O(2) is more effective than 100% O(2)

for resuscitation of newborn infants remains controversial. Objectives: We

have updated the systematic review and meta-analysis including all studies

reporting resuscitation of newborn infants with 21 or 100% O(2). Methods:

Randomized or quasi-randomized studies of depressed newborn infants

resuscitated with 21 or 100% O(2) with or without masking of treatment were

considered for inclusion. The outcomes of interest included neonatal

mortality and hypoxic ischemic encephalopathy. Results: Ten studies

fulfilled the inclusion criteria. Of these, 6 studies were identified as

being strictly randomized. In total, 1,082 infants were allocated to

resuscitation with 21% O(2) and 1,051 infants with 100% O(2). The risk of

neonatal mortality was reduced in the 21% O(2) group compared to the 100%

O(2 )group both in the analysis of all studies (typical RR 0.69, 95% CI

0.54, 0.88) and in the analysis of strictly randomized studies (typical RR

0.32, 95% CI 0.12, 0.84). A trend toward a decrease in the risk of hypoxic

ischemic encephalopathy stage 2 and 3 was noted with resuscitation in 21%

O(2) in the analysis of all studies (typical RR 0.88, 95% CI 0.72, 1.08).

Conclusions: There is a significant reduction in the risk of neonatal

mortality and a trend towards a reduction in the risk of severe hypoxic

ischemic encephalopathy in newborns resuscitated with 21% O(2).

E. Bledsoe, DO, FACEP

Midlothian, Texas

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