Air versus supplemental oxygen for resuscitation of term or late preterm infants at birth.

In 30 seconds

This Cochrane systematic review and meta-analysis assessed randomised and quasi-randomised trials comparing air with supplemental oxygen for resuscitation at birth in term and late preterm infants needing respiratory support. Twelve studies included 2054 infants. Compared with supplemental oxygen, air may reduce all-cause mortality before hospital discharge (RR 0.72, 95% CI 0.57 to 0.91; 10 studies, 1879 participants), based on low-certainty evidence. The review found little to no difference in in-hospital stage II to III hypoxic-ischaemic encephalopathy or mortality among infants followed beyond discharge; evidence for neurodevelopmental impairment was very uncertain.

Key findings

• Air may reduce mortality before discharge compared with supplemental oxygen (RR 0.72, 95% CI 0.57 to 0.91; 10 studies, 1879 participants; low-certainty evidence).
• In-hospital stage II to III hypoxic-ischaemic encephalopathy showed little to no difference (RR 0.88, 95% CI 0.71 to 1.10; 5 studies, 1384 participants; low-certainty evidence).
• Mortality among infants followed beyond discharge showed little to no difference (RR 0.82, 95% CI 0.58 to 1.16; 3 studies, 668 participants; low-certainty evidence).
• Evidence about air’s effect on moderate to severe neurodevelopmental impairment was very uncertain.

Why it matters

The choice of initial oxygen concentration is a practical decision during delivery-room resuscitation. These findings suggest that starting with air may be associated with lower mortality before discharge, while showing no clear difference in the reported neurological and longer-term mortality outcomes. The low certainty of the evidence means the apparent mortality benefit should be interpreted cautiously.

What to keep in mind

Evidence for the main mortality outcome was low certainty, and the review found very uncertain evidence for moderate to severe neurodevelopmental impairment.