We have the following comments to offer on the recent article(1) on this subject:

1. The room air group in treatment failure was switched over to 100% oxygen supplementation after 90 seconds of resuscitation. According to international guidelines for neonatal resuscitation 2000(2), some of the babies in room air group might have received external cardiac massage by then. Generally myocardial failure does not occur until both pH and PaO2 are extremely low, approximately 6.9 and 20 mm of Hg, respectively. Even in the absence of myocardial failure, effective ventilation of the lungs with a high oxygen concentration may correct acidosis by lowering PaCO2, oxygenating the blood and adequately dilating the pulmonary vascular bed(3). Hence the use of room air for both the above situations is not justified.

2. The study included preterm babies also where Sarnat and Sarnat staging was done for documenting HIE which can only be used for babies over 36 weeks of gestation(4).

3. Median apgar score at 1 minute is 3 each in room air and 100% oxygen group as per Table II, whereas in the text it has been stated that room air group had significantly higher 1 minute apgar score than 100% oxygen group.

4. As treatment failure, overall mortality, HIE and asphyxia related mortality are higher in both the groups, it seems that either of two modalities of treatment are not ideal. Perhaps better may be lying in between the two i.e., room air and 100% oxygen. As 100% oxygen has been noted to be associated with a variety of adverse reactions including increased generation of free radicals, decreased central nervous system sodium potassium ATPase func-tion and decreased dopamine meta-bolism(5).