No evidence for superiority of air or oxygen for neonatal resuscitation: a meta-analysis.

摘要

PURPOSE: The aim of this meta-analysis was to re-evaluate the evidence in favour of oxygen or room air as the initial gas mixture for neonatal resuscitation in terms of the following outcomes: death, hypoxic/ischemic encephalopathy, need for tracheal intubation, and APGAR score-Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration-at five minutes. METHODS: A search with no language restriction for all available controlled clinical trials (CCT) was conducted in PUBMED, Cochrane Central Register of Controlled Trials, and EMBASE. Data were extracted independently by the two investigators. RESULTS: Eight CCTs were retained for analysis. They included 1,500 patients, 772 in the oxygen group and 728 in the air group. The evidence is based mainly on quasi-randomized studies (1,311/1,500) with unblinded resuscitators (1,421/1,500). The expertise/training of the resuscitators was unspecified for four of the eight studies. The risk ratio (RR) for death was 1.35 (95% confidence intervals [CI] = 0.97 to 1.88; P = 0.08; I-squared 0%). The RR for hypoxic/ischemic encephalopathy was 1.03 (95% CI = 0.86 to 1.23; P = 0.74; I-squared 0%). The RR for requiring a tracheal intubation was 0.85 (95% CI = 0.69 to 1.05 [random effects model]; P = 0.12; I-squared = 9.51%). CONCLUSIONS: The literature is insufficient to make any statement regarding the superiority of oxygen or room air as the initial gas mixture for neonatal resuscitation.