Room air resuscitation-two decades of neonatal research.

Experimental as well as clinical studies have demonstrated that room air is as efficient as pure oxygen for newborn resuscitation. Recent data even indicate that outcome is improved if pure oxygen is avoided. Thus, in a meta-analysis, neonatal mortality was significantly lower in those newly born infants resuscitated with 21% than with 100% oxygen. Short-term recovery is also improved in the room air group since time to first breath is shorter, heart rate at 90 s and 5 min Apgar score are higher. Animal data indicate that injury in a number of organs, including the brain, is aggravated by giving pure oxygen to newly born depressed infants even for a brief period. Although the optimal oxygen concentration probably is not known for newborn infants in need of resuscitation, pure oxygen should be avoided. These data should be reflected in new guidelines that are under way.