Cardiocirculatory Monitoring during Immediate Fetal-to-Neonatal Transition: A Systematic Qualitative Review of the Literature

Abstract

Background: The fetal-to-neonatal transition is a complex process that includes changes in cardiac and respiratory systems. Objective: The aim of this study is to review the different methods of cardiocirculatory monitoring during the immediate neonatal transition period. Methods: A systematic search of PubMed and Ovid Embase was performed using the following terms: infant, newborn, newborn infant, neonate, neonates, heart, cardiac, blood pressure, haemodynamic, hemodynamics, blood circulation, circulation, echocardiography, ultrasonography, sonography, electrocardiography, ECG, oximetry, pulse, pulse oximetry, monitoring, measurement, acclimatization, adaptation, transition, after birth and delivery room. Additional articles were identified by manual search of cited references. Only human studies describing cardiocirculatory monitoring during the first 15 min after birth were included. Results: Thirteen studies were identified that described heart rate (HR). Additional five studies were identified that measured blood pressure. Four studies performed functional echocardiography during neonatal transition; two in addition to blood pressure monitoring and three in addition to HR monitoring. Conclusion: Routine HR monitoring using electrocardiography or pulse oximetry is used to evaluate adequate hemodynamic transition, and reference ranges have been established. Measuring blood pressure noninvasively though noncontinuously might be of some value in future, considering that the normative data have been established recently. Echocardiographic monitoring during the immediate transition period will improve the knowledge about cardiac function changes, but introduction in clinical routine remains questionable. © 2014 S. Karger AG, Basel

Blood Pressure during the Immediate Neonatal Transition: Is the Mean Arterial Blood Pressure Relevant for the Cerebral Regional Oxygenation?

“…Furthermore, there are 2 noncontinuous methods: measurement of mean arterial blood pressure (MABP) (oscillometric method) and cardiac function (echocardiography) [2,3,4]. In order to guide oxygen therapy, pulse oximetry is recommended by neonatal resuscitation guidelines [5,6,7].…”

Optimising Intravenous Volume Resuscitation of the Newborn in the Delivery Room: Practical Considerations and Gaps in Knowledge

“…A recent review identified 4 studies of cardiac-output ECHO monitoring during term newborn stabilization [24]. These studies confirm that ECHO assessment of neonatal transition (ductal haemodynamics, and changes in right and left ventricular outputs) is feasible as an objective adjunct to determining newborn haemodynamic status [26,27,28].…”

“…A number of studies have shown that BP measurements are obtainable in the DR [24,25]. However, such non-invasive BP measurements are not reliably consistent, especially in preterm neonates, and invasive BP monitoring is not practical in the DR setting [3].…”

Enhanced Monitoring of the Preterm Infant during Stabilization in the Delivery Room

“…A recent review by Baik et al identified four studies of echocardiographic monitoring during newborn stabilization ( 42 ). Each study assessed term infants only ( 43 – 46 ).…”