28 April 2011

Resuscitation of Newborn Infants: from Oxygen to Room Air.

About 10% of newborns have some difficulty initiating respirations.  Many of these infants respond quickly following brief stimulation.  Others require some mechanical help with an ambu bag or anesthesia bag to begin breathing.  For many years it has been assumed that using supplemental oxygen, even 100% oxygen, improved outcomes, and was used uncritically wherever available.  A recent large study (1), showed that newborns resuscitated using 21% oxygen (room air) had higher Apgar scores, and took their first breath an average of 30 seconds earlier.  The most important finding, however, was that using the lower oxygen concentration was associated with a lower mortality.  Metanalysis of other studies showed a 30% reduction in mortality when babies were resuscitated with room air.  Saugstad(1) points out that this means 100,000 newborn lives could be saved each year by switching from oxygen to ambient air for the initial treatment of newborn babies who require assistance with breathing.  These findings are of major significance for those of us who work with village midwives and health workers.  We can reassure them that routine use of Oxygen is not indicated for resuscitating newborns at delivery.  A better use of resources would be to provide them with simple Ambu bages and train them in their use.
Saugstad, O.  Resuscitation of Newborn Infants:  from Oxygen to Room Air.  Lancet 376, p1970-71, Dec 2010.
Submitted by Roger Boe MD  UMVIM Medical Consultant

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