***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective . Birth asphyxia represents a serious problem worldwide , result ing in ∼1 million deaths and an equal number of serious sequelae annually . It is therefore important to develop new and better ways to treat asphyxia . Resuscitation after birth asphyxia traditionally has been carried out with 100 % oxygen , and most guidelines and textbooks recommend this ; however , the scientific background for this has never been established . On the contrary , theoretic considerations indicate that resuscitation with high oxygen concentrations could have detrimental effects . We have performed a series of animal studies as well as one pilot study indicating that resuscitation can be performed with room air just as efficiently as with 100 % oxygen . To test this more thoroughly , we organized a multicenter study and hypothesized that room air is superior to 100 % oxygen when asphyxiated newborn infants are resuscitated . Methodology . In a prospect i ve , international , controlled multicenter study including 11 centers from six countries , asphyxiated newborn infants with birth weight > 999 g were allocated to resuscitation with either room air or 100 % oxygen . The study was not blinded , and the patients were allocated to one of the two treatment groups according to date of birth . Those born on even date s were resuscitated with room air and those born on odd date s with 100 % oxygen . Informed consent was not obtained until after the initial resuscitation , an arrangement in agreement with the new proposal of the US Food and Drug Administration 's rules governing investigational drugs and medical devices to permit clinical research on emergency care without the consent of subjects . The protocol was approved by the ethical committees at each participating center . Entry criterion was apnea or gasping with heart rate < 80 beats per minute at birth necessitating resuscitation . Exclusion criteria were birth weight < 1000 g , lethal anomalies , hydrops , cyanotic congenital heart defects , and stillbirths . Primary outcome measures were death within 1 week and /or presence of hypoxic – ischemic encephalopathy , grade II or III , according to a modification of Sarnat and Sarnat . Secondary outcome measures were Apgar score at 5 minutes , heart rate at 90 seconds , time to first breath , time to first cry , duration of resuscitation , arterial blood gases and acid base status at 10 and 30 minutes of age , and abnormal neurologic examination at 4 weeks . The existing routines for resuscitation in each participating unit were followed , and the ventilation techniques described by the American Heart Association were used as guidelines aim ing at a frequency of manual ventilation of 40 to 60 breaths per minute . Results . Forms for 703 enrolled infants from 11 centers were received by the steering committee . All 94 patients from one of the centers were excluded because of violation of the inclusion criteria in 86 of these . Therefore , the final number of infants enrolled in the study was 609 ( from 10 centers ) , with 288 in the room air group and 321 in the oxygen group . Median ( 5 to 95 percentile ) gestational ages were 38 ( 32.0 to 42.0 ) and 38 ( 31.1 to 41.5 ) weeks ( NS ) , and birth weights were 2600 ( 1320 to 4078 ) g and 2560 ( 1303 to 3900 ) g ( NS ) in the room air and oxygen groups , respectively . There were 46 % girls in the room air and 41 % in the oxygen group ( NS ) . Mortality in the first 7 days of life was 12.2 % and 15.0 % in the room air and oxygen groups , respectively ; adjusted odds ratio ( OR ) = 0.82 with 95 % confidence intervals ( CI ) = 0.50–1.35 . Neonatal mortality was 13.9 % and 19.0 % ; adjusted OR = 0.72 with 95 % CI = 0.45–1.15 . Death within 7 days of life and /or moderate or severe hypoxic – ischemic encephalopathy ( primary outcome measure ) was seen in 21.2 % in the room air group and in 23.7 % in the oxygen group ; OR = 0.94 with 95 % CI = 0.63–1.40 . Heart rates did not differ between the two groups at any time point and were ( mean ± SD ) 90 ± 31 versus 93 ± 33 beats per minute at 1 minute and 110 ± 27 versus 113 ± 30 beats per minute at 90 seconds in the room air and oxygen groups , respectively . Apgar scores at 1 minute ( median and 5 to 95 percentiles ) were significantly higher in the room air group ( 5 [ 1 to 6.7 ] ) than in the oxygen group ( 4 [ 1 to 7 ] ) ; however , at 5 minutes there were no significant differences , with 8 ( 4 to 9 ) versus 7 ( 3 to 9 ) . There were significantly more infants with very low 1-minute Apgar scores ( < 4 ) in the oxygen group ( 44.4 % ) than in the room air group ( 32.3 % ) . There also were significantly more infants with 5-minute Apgar score < 7 in the oxygen group ( 31.8 % ) than in the room air group ( 24.8 % ) . There were no differences in acid base status or Sao 2during the observation period between the two groups . Mean ( SD ) Pao 2 was 31 ( 17 ) versus 30 ( 22 ) mm Hg in cord blood in the room air and oxygen groups , respectively ( NS ) . At 10 minutes Pao 2 was 76 ( 32 ) versus 87 ( 49 ) mm Hg ( NS ) , and at 30 minutes , the values were 74 ( 29 ) versus 89 ( 42 ) mm Hg in the room air and oxygen groups , respectively . Median ( 95 % CI ) time to first breath was 1.1 ( 1.0–1.2 ) minutes in the room air group versus 1.5 ( 1.4 to 1.6 ) minutes in the oxygen group . Time to the first cry also was in mean 0.4 minute shorter in the room air group compared with the oxygen group . In the room air group , there were 25.7 % so-called resuscitation failures ( bradycardia and /or central cyanosis after 90 seconds ) that were switched to 100 % oxygen after 90 seconds . The percentage of resuscitation failures in the oxygen group was 29.8 % . Conclusions . This study with patients enrolled primarily from developing countries indicates that asphyxiated newborn infants can be resuscitated with room air as efficiently as with pure oxygen . In fact , time to first breath and first cry was significantly shorter in room air- versus oxygen-resuscitated infants . Resuscitation with 100 % oxygen may depress ventilation and therefore delay the first breath . More studies are needed confirming these results before resuscitation guidelines are changed Objective : Use of  video recordings of newborn infants to determine : ( 1 ) if clinicians agreed whether infants were pink ; and ( 2 ) the pulse oximeter oxygen saturation ( Spo2 ) at which infants first looked pink . Methods : Selected clips from video recordings of infants taken immediately after delivery were shown to medical and nursing staff . The infants received varying degrees of resuscitation ( including none ) and were monitored with pulse oximetry . The oximeter readings were obscured to observers but known to the investigators . A timer was visible and the sound was inaudible . The observers were asked to indicate whether each infant was pink at the beginning , became pink during the clip , or was never pink . If adjudged to turn pink during the clip , observers recorded the time this occurred and the corresponding Spo2 was determined . Results : 27 clinicians assessed videos of 20 infants ( mean ( SD ) gestation 31(4 ) weeks ) . One infant ( 5 % ) was perceived to be pink by all observers . The number of clinicians who thought each of the remaining 19 infants were never pink varied from 1 ( 4 % ) to 22 ( 81 % ) . Observers determined the 10 infants with a maximum Spo2 ⩾95 % never pink on 17 % ( 46/270 ) of occasions . The Spo2 at which individual infants were perceived to turn pink varied from 10 % to 100 % . Conclusion : Among clinicians observing the same videos there was disagreement about whether newborn infants looked pink with wide variation in the Spo2 when they were considered to become pink Background Resuscitation at birth with 100 % oxygen is known to increase the oxidative burden with concomitant deleterious effects . Although fractions of inspired oxygen ( FiO2 ) < 100 % are widely used in preterm infants , starting resuscitation at a ( too ) low FiO2 may result in hypoxia . The objective of this study is to compare the safety and efficacy of resuscitating very preterm infants with an initial FiO2 of 30 % versus 65 % . Methods / design In this double-blind , r and omized controlled trial , 200 very preterm infants with a gestational age < 32 weeks will be r and omized to start resuscitation after birth with either 30 % or 65 % oxygen . The FiO2 will be adjusted based on oxygen saturation measured by pulse oximetry ( SpO2 ) and pulse rate ( which should be over 100 beats per minute ) in order to achieve a target SpO2 of 88–94 % at 10 min of life . The FiO2 and pulse oximetry data will be continuously recorded . The primary outcome is survival without bronchopulmonary dysplasia , as assessed by a physiological test at 36 weeks postmenstrual age . The secondary outcomes include the time to achieve SpO2 > 88 % , Apgar score at 5 min , cumulative O2 exposure , oxidative stress ( as determined by glutathione synthesis and oxidative stress markers ) , retinopathy of prematurity , brain injury and neurodevelopmental outcome at 2 years of age . This study will provide insight into determining the appropriate initial FiO2 to start resuscitation of very preterm infants . Trial registration http://www.trialregister.nl , NTR243 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more To determine if the use of oxygen in the delivery room influences subsequent global cerebral blood flow ( CBF ) , 70 infants of gestational age of less than 33 completed weeks were r and omly assigned to receive room air ( group I ) or 80 % oxygen ( group II ) during the initial stabilisation at birth . In group I supplemental oxygen was administered on clinical indications , when required . After being admitted to the neonatal intensive care unit all infants were treated according to our normal practice . At a postnatal age of 2 hours CBF was measured by xenon clearance . Seventy four per cent of the infants in group I were successfully stabilised without the need for supplemental oxygen . CBF was significantly higher in group I than in group II ( CBF median ( interquartile range ) : 15.9 ( 13.6 - 21.9 ) v 12.2 ( 10.7 - 13.8 ) ml/100 g/minute ) . Differences in oxygen exposure seemed to be the only explanation for the differences in CBF . No differences in short term outcome were found between the groups I n October 2010 , the International Liaison Committee on Resuscitation released new guidelines for neonatal resuscitation , which exp and ed on the previous recommendations for the use of pulse oximetry during neonatal resuscitation . In this Commentary , we discuss oxygen treatment in the delivery room . Where available , we have used evidence from r and omized controlled trials ( RCTs ) . Where this evidence is lacking , we have relied on observational and animal data to inform our strategy for using supplemental oxygen in the delivery room OBJECTIVE . In this study of preterm neonates of < 32 weeks , we prospect ively compared the use of room air versus 100 % oxygen as the initial resuscitation gas . METHODS . A 2-center , prospect i ve , r and omized , controlled trial of neonates with gestational ages of 23 to 32 weeks who required resuscitation was performed . The oxygen group was initially resuscitated with 100 % oxygen , with decreases in the fraction of inspired oxygen after 5 minutes of life if pulse oxygen saturation was > 95 % . The room air group was initially resuscitated with 21 % oxygen , which was increased to 100 % oxygen if compressions were performed or if the heart rate was < 100 beats per minute at 2 minutes of life . Oxygen was increased in 25 % increments if pulse oxygen saturation was < 70 % at 3 minutes of life or < 80 % at 5 minutes of life . RESULTS . Twenty-three infants in the oxygen group ( mean gestational age : 27.6 weeks ; range : 24–31 weeks ; mean birth weight : 1013 g ; range : 495–2309 g ) and 18 in the room air group ( mean gestational age : 28 weeks ; range : 25–31 weeks ; mean birth weight : 1091 g ; range : 555–1840 g ) were evaluated . Every resuscitated patient in the room air group met rescue criteria and received an increase in the fraction of inspired oxygen by 3 minutes of life , 6 patients directly to 100 % and 
    Output:
    
CONCLUSIONS The available trial data do not provide strong evidence that using lower versus higher oxygen concentrations for delivery room transition support for preterm infants confers important benefits or harms .