Question: With regards to neonatal resuscitation, are we to provide room air PPV for 30sec (as per ALS PCS), or provide room air PPV for 90sec (as per AHA guidelines)? Also, why is room air the preferable choice for initial PPV over 100% O2? (Updated)

If the baby is bradycardic (HR < 60 per minute) after 90seconds of resuscitation with a lower concentration of oxygen, oxygen concentration should be increased to 100% until recovery of a normal heart rate (Class IIb, LOE B). (Kattwinkel et al, Part 15: Neonatal Resuscitation, page S912)Research has shown that room air ventilation in neonates is superior to 100% oxygen and may result in lower mortality rates (Rabi, Rabi, & Yee, 2007).

It has been found that hyperoxia slows cerebral blood flow in neonates and exposure to 100% oxygen (even brief) causes long-term deficits in cerebral blood flow. High concentrations of oxygen are also related to free radical formation, which has a significant role in reperfusion injury following asphyxia (Davis, Tan, O'Donnell, & Schultz, 2004).References:Davis, P. G., Tan, A., O'Donnell, P. F., & Schultz, A. (2004). Resuscitation of newborn infants with 100% oxygen or air: A systematic review and meta-analysis. Lancet. 364, 1329-1333. Rabi, Y., Rabi, D., and Yee, W. (2007). Room air resuscitation of the depressed newborn: A systematic review and meta-analysis. Resuscitation. 72, 353-363.

*This question was updated on February 7th 2020

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