Virtually every resuscitation guideline
mandates use of oxygen in neonates. However, adverse effects of pure
oxygen on cerebral perfusion have been noted in newborns. An
international collaboration of investigators conducted a
meta-analysis of five prospective clinical trials (2 randomized, 3
quasi-randomized; 2 blinded, 3 unblinded)
in which air was compared with 100% oxygen in 1302 asphyxiated (low
heart rate, apneic) newborn infants (average weight,
>2400 g). Most infants were born near term in developing countries.
No single study showed a difference in
mortality risk, but pooled analysis showed a significant reduction
in mortality risk among infants who were resuscitated with air
(relative risk, 0.71; number needed to treat to prevent 1 death,
20). No significant differences were noted in the occurrence of
encephalopathy, cerebral palsy, or developmental outcomes.
Comment: Are these results real? An editorialist notes they
are consistent with findings of a previous meta-analysis, but whether
the results can be generalized to infants born in developed countries
is unclear. No information is provided about meconium
aspiration, sepsis, or gestational age at birth. In addition, care
was provided largely in hospitals with limited postnatal resources.
Nevertheless, these results should make us rethink the use of pure
oxygen therapy for full-term infants who are asphyxiated. We have
been wrong about oxygen therapy in the past (as with retinopathy of prematurity), and it is quite possible that we
are wrong again.
—
Published in Journal Watch October 29, 2004
Source
Davis PG et al. Resuscitation
of newborn infants with 100% oxygen or air: A systematic review and
meta-analysis. Lancet 2004 Oct 9; 364:1329-33.
[Medline
abstract][Download
citation]
Hansmann G. Neonatal resuscitation on air: It is time to
turn down the oxygen tanks? Lancet 2004 Oct 9; 364:1293-4.
[Medline
abstract][Download
citation]