Neurodevelopmental outcome of infants resuscitated with air or 100% oxygen: a systematic review and meta-analysis.
BACKGROUND
The use of air for the initial resuscitation of newborn infants has been shown to reduce neonatal mortality. However, a precise estimate of the neurodevelopmental status upon follow-up of infants resuscitated in air is lacking.


OBJECTIVE
To perform a meta-analysis of all studies reporting resuscitation of newborn infants with air or 100% oxygen that included follow-up data.


METHODS
Bibliographic databases were searched. In addition, we estimated the effect of loss to follow-up on our analysis of abnormal neurodevelopmental outcome.


RESULTS
We identified 10 studies in which newborn infants had been randomly or quasi-randomly assigned to resuscitation with air or 100% oxygen. Three of these 10 studies had available follow-up data. A total of 678 infants were enrolled at centers that performed follow-up of these infants. Of these, 113 died, leaving 565 infants potentially eligible for follow-up. A total of 414 children were evaluated (73% of eligible children; 195 resuscitated with air and 219 with 100% oxygen). In the air group, 12.8% of infants had an abnormal neurodevelopmental outcome, compared with 10.5% in the 100% oxygen group [typical relative risk (RR) 1.24, 95% confidence interval 0.73-2.10]. This is consistent with an RR of abnormal development as low as 0.41 or as high as 2.28.


CONCLUSIONS
Long-term follow-up did not detect any significant differences in these two groups regarding abnormal development. However, the results are imprecise and could be consistent with significant harm or benefit.
Department of Pediatric Research, Oslo University Hospital, University of Oslo, Oslo, Norway. odsaugstad@rr-research.no
Ola Didrik
OD
Saugstad
Maximo
M
Vento
Siddarth
S
Ramji
Diantha
D
Howard
Roger F
RF
Soll
D000388:Air; D002657:Child Development; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000401:mortality / Q000628:therapy*; D009420:Nervous System / Q000254:growth & development*; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects* / Q000401:mortality; D012151:Resuscitation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors