• Ola Didrik Saugstad, Siddarth Ramji, Roger F Soll, and Maximo Vento.
• Department of Paediatric Research, Rikshospitalet Medical Centre, University of Oslo, Oslo, Norway. odsaugstad@rr-research.no
• Neonatology. 2008 Jan 1;94(3):176-82.

BackgroundThe issue of whether 21% O(2) is more effective than 100% O(2) for resuscitation of newborn infants remains controversial.ObjectivesWe have updated the systematic review and meta-analysis including all studies reporting resuscitation of newborn infants with 21 or 100% O(2).MethodsRandomized 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.ResultsTen 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).ConclusionsThere 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).(c) 2008 S. Karger AG, Basel.

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