***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 ABSTRACT : To test the hypothesis that room air is superior to 100 % oxygen when asphyxiated newborns are resuscitated , 84 neonates ( birth weight > 999 g ) with heart rate < 80 and /or apnea at birth were allocated to be resuscitated with either room air ( n = 42 ) or 100 % oxygen ( n = 42 ) . Serial , unblinded observations of heart rates at 1 , 3 , 5 , and 10 min and Apgar scores at 1 min revealed no significant differences between the two groups . At 5 min , median ( 25th and 75th percentile ) Apgar scores were higher in the room air than in the oxygen group [ 8 ( 7–9 ) versus 7 ( 6–8 ) , p = 0.03 ] . After the initial resuscitation , arterial partial pressure of oxygen , pH , and base excess were comparable in the two groups . Assisted ventilation was necessary for 2.4 ( 1.5–3.4 ) min in the room air group and 3.0 ( 2.0–4.0 ) min in the oxygen group ( p = 0.14 ) . The median time to first breath was 1.5 ( 1.0–2.0 ) min in both the room air and oxygen groups ( p = 0.59 ) , and the time to first cry was 3.0 ( 2.0–4.0 ) min and 3.5 ( 2.5–5.5 ) min in the room air and oxygen groups , respectively ( p = 0.19 ) . Three neonates in the room air group and four in the oxygen group died in the neonatal period . At 28 d , 72 of the 77 surviving neonates were available for follow-up ( 36 in each group ) , and none had any neurologic sequelae . This preliminary study did not provide conclusive evidence that room air is superior to 100 % oxygen in the resuscitation of  asphyxiated newborns , although it indicated that room air is as effective as 100 % oxygen . Additional trials with increased numbers of patients are necessary before deciding whether room air or oxygen should be used in clinical practice 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 OBJECTIVE To follow-up children who had been resuscitated at birth with either 21 % or 100 % oxygen ( O2 ) . METHODS A multicenter study with 10 participating centers recruited 609 infants to the Resair 2 study where resuscitation was performed with either 21 % or 100 % O2 . A follow-up between ages 18 and 24 months was performed . However , during follow-up registration , it was found that 18 infants had been enrolled twice in the original Resair 2 study with different registration numbers , leaving 591 enrolled in the Resair 2 study and 410 enrolled in the 7 centers participating in the follow-up . Of these 410 infants , 79 died ( 76 in the neonatal and 3 in the postneonatal period ) . Furthermore , for 8 infants informed consent was not obtained , leaving 323 eligible for follow-up . Of these , 213 infants ( 66 % ) were followed-up : 91 ( 62 % ) had been resuscitated with 21 % O2 , and 122 ( 69 % ) with 100 % O2 . At a median age of 22 and 20 months ( not significant ) in the 21 % and 100 % groups , respectively , a simple question naire was filled out and neurologic assessment was performed in addition to measuring anthropometric data . RESULTS There were no significant differences in weight , height , or head circumference between the 2 groups . Cerebral palsy developed in 10 % and 7 % , respectively , in the 2 groups ( not significant ) . In total , 11 cases ( 12 % ) in the 21 % versus 11 cases ( 9 % ) in the 100 % O(2 ) group ( odds ratio : 1.39 , 95 % confidence interval : 0.57 - 3.36 ) developed cerebral palsy and /or mental or other delay . Furthermore , it was concluded that 14 ( 15 % ) in the 21 % group and 12 ( 10 % ) in the 100 % group were not normal ( odds ratio : 1.67 , 95 % confidence interval : 0.73 - 3.80 ) . CONCLUSIONS There were no significant differences in somatic growth or neurologic h and icap at an age of 18 to 24 months in infants resuscitated with either 21 % or 100 % O2 at birth . Based on these data , resuscitation with ambient air seems to be safe , at least in most cases . More studies are needed to settle this issue Background . Traditionally , asphyxiated newborn infants have been ventilated using 100 % oxygen . However , a recent multinational trial has shown that the use of room air was just as efficient as pure oxygen in securing the survival of severely asphyxiated newborn infants .  Oxidative stress markers in moderately asphyxiated term newborn infants resuscitated with either 100 % oxygen or room air have been studied for the first time in this work . Methods . Eligible term neonates with perinatal asphyxia were r and omly resuscitated with either room air or 100 % oxygen . The clinical parameters recorded were those of the Apgar score at 1 , 5 , and 10 minutes , the time of onset of the first cry , and the time of onset of the sustained pattern of respiration . In addition , reduced and oxidized glutathione concentrations and antioxidant enzyme activities ( superox 
    Output:
    
There is insufficient evidence at present on which to recommend a policy of using room air over 100 % oxygen , or vice versa , for newborn resuscitation .
A reduction in mortality has been seen in infants resuscitated with room air , and no evidence of harm has been demonstrated .