Resuscitation 96 (2015) 252–259 Contents lists available at ScienceDirect Resuscitation jou rn al hom epage : w ww.elsevie r.com/locate/resuscitation Clinical Paper Outcomes of preterm infants following the introduction of room air resuscitation  Yacov Rabi a,b,∗ , Abhay Lodha a,b,c,1 , Amuchou Soraisham a,b,1 , Nalini Singhal a,b,2 , Keith Barrington d,3 , Prakesh S. Shah e,f,4 a Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada b Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada c Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada d Sainte Justine University Health Centre, Montréal, Quebec, Canada e Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada f Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada a r t i c l e i n f o Article history: Received 22 May 2015 Received in revised form 12 August 2015 Accepted 17 August 2015 Keywords: Oxygen Infant Premature Resuscitation Neonatal intensive care a b s t r a c t Background: After 2006 most neonatal intensive care units (NICUs) in Canada stopped initiating newborn resuscitation with 100% oxygen. Methods: In this retrospective cohort study, we compared neonatal outcomes in infants born at ≤27 weeks gestation that received <100% oxygen (OX titrate group, typically 21–40% oxygen) during delivery room resuscitation to infants that received 100% oxygen (OX 100 group). Results: Data from 17 NICUs included 2326 infants, 1244 in the OX titrate group and 1082 in the OX 100 group. The adjusted odds ratio (AOR) for the primary outcome of severe neurologic injury or death was higher in the OX titrate group compared with the OX 100 group (AOR 1.36; 95% CI 1.11, 1.66). A similar increase was also noted when comparing infants initially resuscitated with room air to the OX 100 group (AOR 1.33; 95% CI 1.04, 1.69). Infants in the OX titrate group were less likely to have received either medical or surgical treatment for a patent ductus arteriosus (AOR 0.53; 95% CI 0.37, 0.74). Conclusions: In Canadian NICUs, we observed a higher risk of severe neurologic injury or death among preterm infants of ≤27 weeks gestation following a change in practice to initiating resuscitation with either room air or an intermediate oxygen concentration. © 2015 Elsevier Ireland Ltd. All rights reserved. Abbreviations: AOR, adjusted odds ratio; CNN, Canadian Neonatal Network; FiO2, inspired concentration of oxygen; ILCOR, International Liaison Committee on Resus- citation; NICU, neonatal intensive care unit; NRP, Neonatal Resuscitation Program; OX100 group, group of infants resuscitated with static concentration of 100% oxygen as per local policies; OX titrate group, group of infants resuscitated using oxygen titra- tion as per local policies; OX21 subgroup, subgroup of OX titrate initially resuscitated with 21% oxygen; OX22–100 subgroup, subgroup of OX titrate initially resuscitated >21% oxygen; PDA, patent ductus arteriosus; SNAPII, score for neonatal acute physiology version II.  A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2015.08.012. ∗ Corresponding author at: Department of Paediatrics, Section of Neonatal- Perinatal Medicine, Foothills Medical Centre, Room C211, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada. E-mail addresses: jack.rabi@albertahealthservices.ca (Y. Rabi), abhay.lodha@albertahealthservices.ca (A. Lodha), amuchou.soraisham@albertahealthservices.ca (A. Soraisham), nalini.singhal@albertahealthservices.ca (N. Singhal), keith.barrington@mcgill.ca (K. Barrington), PShah@mtsinai.on.ca (P.S. Shah). Introduction Guidelines for oxygen use during newborn resuscitation have changed repeatedly over the past 10 years as new evidence regard- ing the perils of excessive oxygen exposure became available. In 2005, the International Liaison Committee on Resuscitation (ILCOR) published recommendations stating there was “insuffi- cient evidence to specify the concentration of oxygen to be used 1 Department of Paediatrics, Section of Neonatal-Perinatal Medicine, Foothills Medical Centre, Room C211, 1403 29 Street NW, Calgary, Alberta, Canada T2N 2T9. 2 Department of Paediatrics, Section of Neonatal-Perinatal Medicine, Alberta Chil- dren’s Hospital, 2888 Shaganappi Trail Northwest, Calgary, Alberta, Canada T3B 6A8. 3 Department of Paediatrics, Section of Neonatal-Perinatal Medicine, Sainte Jus- tine University Health Center, 2900, boul. Édouard-Montpetit, Montréal, Québec, Canada H3T 1J4. 4 Department of Paediatrics, Section of Neonatal-Perinatal Medicine, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada M5G 1X5. http://dx.doi.org/10.1016/j.resuscitation.2015.08.012 0300-9572/© 2015 Elsevier Ireland Ltd. All rights reserved.