TY - JOUR
T1 - Room air for initiating term newborn resuscitation
T2 - A systematic review with meta-analysis
AU - Welsford, Michelle
AU - Nishiyama, Chika
AU - Shortt, Colleen
AU - Isayama, Tetsuya
AU - Dawson, Jennifer Anne
AU - Weiner, Gary
AU - Roehr, Charles Christoph
AU - Wyckoff, Myra H
AU - Rabi, Yacov
N1 - Funding Information:
Funded by the American Heart Association on behalf of the International Liaison Committee on Resuscitation. The funder was involved in the International Liaison Committee on Resuscitation process but had no role in this systematic review study design, data collection and analysis, or preparation of the article.
Publisher Copyright:
Copyright © 2019 by the American Academy of Pediatrics.
PY - 2019/1
Y1 - 2019/1
N2 - CONTEXT: The International Liaison Committee on Resuscitation prioritized to rigorously review the initial fraction of inspired oxygen (Fio 2 ) during resuscitation of newborns. OBJECTIVE: This systematic review and meta-analysis provides the scientific summary of initial Fio2 in term and late preterm newborns (≥35 weeks' gestation) who receive respiratory support at birth. DATA SOURCES: Medline, Embase, Evidence Based Medicine Reviews, and Cumulative Index to Nursing and Allied Health Literature were searched between January 1, 1980 and August 10, 2018. STUDY SELECTION: Studies were selected by pairs of independent reviewers in 2 stages, with a Cohen's κ of 0.8 and 1.0. DATA EXTRACTION: Pairs of independent reviewers extracted data, appraised risk of bias, and assessed Grading of Recommendations Assessment, Development and Evaluation certainty of evidence. RESULTS: Five randomized controlled trials (RCTs) and 5 quasi RCTs included 2164 patients. Room air (Fio 2 0.21) was associated with a statistically significant benefit in short-term mortality compared with 100% oxygen (Fio 2 1.0) (7 RCTs; n = 1469; risk ratio [RR] = 0.73; 95% confidence interval [CI]: 0.57 to 0.94). No significant differences were observed in neurodevelopmental impairment (2 RCTs; n = 360; RR = 1.41; 95% CI: 0.77 to 2.60) or hypoxic-ischemic encephalopathy (5 RCTs; n = 1315; RR = 0.89; 95% CI: 0.68 to 1.18). LIMITATIONS: The Grading of Recommendations Assessment, Development and Evaluation certainty of evidence was low for short-term mortality and hypoxic-ischemic encephalopathy and very low for neurodevelopmental impairment. CONCLUSIONS: Room air has a 27% relative reduction in short-term mortality compared with Fio 2 1.0 for initiating neonatal resuscitation ≥35 weeks' gestation.
AB - CONTEXT: The International Liaison Committee on Resuscitation prioritized to rigorously review the initial fraction of inspired oxygen (Fio 2 ) during resuscitation of newborns. OBJECTIVE: This systematic review and meta-analysis provides the scientific summary of initial Fio2 in term and late preterm newborns (≥35 weeks' gestation) who receive respiratory support at birth. DATA SOURCES: Medline, Embase, Evidence Based Medicine Reviews, and Cumulative Index to Nursing and Allied Health Literature were searched between January 1, 1980 and August 10, 2018. STUDY SELECTION: Studies were selected by pairs of independent reviewers in 2 stages, with a Cohen's κ of 0.8 and 1.0. DATA EXTRACTION: Pairs of independent reviewers extracted data, appraised risk of bias, and assessed Grading of Recommendations Assessment, Development and Evaluation certainty of evidence. RESULTS: Five randomized controlled trials (RCTs) and 5 quasi RCTs included 2164 patients. Room air (Fio 2 0.21) was associated with a statistically significant benefit in short-term mortality compared with 100% oxygen (Fio 2 1.0) (7 RCTs; n = 1469; risk ratio [RR] = 0.73; 95% confidence interval [CI]: 0.57 to 0.94). No significant differences were observed in neurodevelopmental impairment (2 RCTs; n = 360; RR = 1.41; 95% CI: 0.77 to 2.60) or hypoxic-ischemic encephalopathy (5 RCTs; n = 1315; RR = 0.89; 95% CI: 0.68 to 1.18). LIMITATIONS: The Grading of Recommendations Assessment, Development and Evaluation certainty of evidence was low for short-term mortality and hypoxic-ischemic encephalopathy and very low for neurodevelopmental impairment. CONCLUSIONS: Room air has a 27% relative reduction in short-term mortality compared with Fio 2 1.0 for initiating neonatal resuscitation ≥35 weeks' gestation.
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U2 - 10.1542/peds.2018-1825
DO - 10.1542/peds.2018-1825
M3 - Review article
C2 - 30578325
AN - SCOPUS:85059385173
SN - 0031-4005
VL - 143
JO - Pediatrics
JF - Pediatrics
IS - 1
M1 - e20181825
ER -