Up to 10% of babies worldwide need to be resuscitated

An international team, including a doctor from Manchester's Booth Hall Children's Hospital, analysed studies looking at over 1,300 babies.

Writing in The Lancet, they said air should be used to resuscitate babies born at full-term or who were born just a few weeks prematurely.

The finding contradicts a long-held belief that oxygen is best for babies.

The evidence for mortality reduction with air is striking Dr Georg Hansmann, Stanford University

Between five and 10% of newborn babies worldwide require assistance with breathing after delivery.

It has been standard practice for decades to use oxygen to resuscitate babies, because it has been believed that pure oxygen is more beneficial.

But there are concerns that using 100% oxygen can reduce blood flow to the brain in newborn babies.

Units in the UK use 100% oxygen treatment, though some are beginning to investigate the use of air, either on its own or mixed with oxygen.

Back-up

The researchers analysed results from five studies of 1,302 newborn infants that compared resuscitation with air versus 100% oxygen.

On average, the babies were born at an average of 38 weeks. Most were from developing countries, and had moderate breathing problems.

Although no individual study reported a significant difference in death rate, when the trials were combined in a meta-analysis, 5% fewer babies given air died compared with babies given 100% oxygen.

No differences were found in long-term follow-up of neurological problems.

Dr Peter Davis of the Royal Women's Hospital in Melbourne, Australia who led the study, said: "One death would be prevented for every 20 babies resuscitated with air rather than 100% oxygen.

"For term and near-term infants, we can reasonably conclude that air should be used initially, with oxygen as back-up if initial resuscitation fails."

Oxygen levels

The researchers say their findings cannot be directly translated to the UK because of the differences in the healthcare and health of the women and children in the countries studied.

But Dr Anton Tan, a consultant paediatrician at Booth Hall Children's Hospital in Manchester, who also worked on the research, said it did show that air was at least as good a treatment as oxygen.

He told BBC News Online: "It may be in the future that children who are clearly oxygen-deprived would be given 100% oxygen but babies who are born extremely prematurely, or who are less oxygen deprived, will be resuscitated with a lower concentration of oxygen."

Dr Sam Richmond, chair of the newborn life support committee of Resuscitation Council, said updated international guidelines on newborn resuscitation, due out next year, would consider the issue of air versus oxygen.

He was not surprised by the findings, saying: "People have been worried about oxygen for some time.

"It would seem reasonable to say that, if you are resuscitating a baby who is full-term or just slightly early, you should try room air, and if that does not seem to be having an effect, move on to oxygen."