Compliance with Guidelines and Efficacy of Heart Rate Monitoring during Newborn Resuscitation: A Prospective Video Study

Abstract

Objective: Newborn resuscitation guidelines recommend initial assessment of heart rate (HR) and initiation of positive pressure ventilation (PPV) within 60 s after birth in nonbreathing newborns. Pulse oximeter (PO) and electrocardiogram (ECG) are suggested methods for continuous HR monitoring during resuscitation. Our aim was to evaluate compliance with guidelines and the efficacy of PO versus ECG monitoring in real-life newborn resuscitations. Methods: In this prospective observational study, we video recorded resuscitations of newborns ≥34 weeks of gestation receiving PPV at birth. Results: 104 resuscitations were analysed. Median (IQR) time from birth to arrival at the resuscitation bay was 48 (22-68) s (n = 62), to initial HR assessment 70 (47-118) s (n = 61), and to initiation of PPV 78 (42-118) s (n = 62). Initial HR assessment (stethoscope or palpation) and initiation of PPV were achieved within 60 s for 35% of the resuscitated newborns. Time to initial HR assessment and initiating PPV was significantly longer following vaginal deliveries than caesarean sections: 84 (70-139) versus 44 (30-66) s (p < 0.001) and 93 (73-139) versus 38 (30-66) s (p < 0.001). Time from birth and sensor application to provision of a reliable HR signal from PO versus ECG was 348 (217-524) (n = 42) versus 174 (105-277) s (n = 30) (p < 0.001) and 199 (77-352) (n = 65) versus 16 (11-22) s (n = 52) (p < 0.001). Conclusion: Initial HR assessment and initiation of PPV were achieved within 60 s after birth in only 1/3 of newborn resuscitations. When applied for continuous HR monitoring, ECG was superior to PO in time to achieve reliable HR signals in real-life resuscitations.

Heart rate detection properties of dry-electrode ECG compared to conventional 3-lead gel-electrode ECG in newborns

“…To obtain rapid and reliable heart rate monitoring during newborn resuscitation is challenging. Comparative studies show that electrocardiogram (ECG) provide feedback of heart rate earlier than pulse oximetry, and pulse oximetry can underestimate initial heart rate [4][5][6][7][8][9]. The International Liaison Committee on Resuscitation (ILCOR) suggests using ECG for accurate estimation of heart rate during newborn resuscitation, and emphasizes the importance of speed and reliablity [3,10].…”

Changes in heart rate from 5 s to 5 min after birth in vaginally delivered term newborns with delayed cord clamping

“…4 Furthermore, ECG detects heart rate much earlier compared with pulse oximetry. [5][6][7][8] A novel newborn heart rate metre based on dry electrode ECG allows reliable heart rate monitoring at 3-10 s after birth, 9 even earlier than previously achieved by conventional three-lead gel electrode ECG. 4 6 Delayed cord clamping, defined as that occurring beyond 1 min after birth, is increasingly implemented as standard of care worldwide and might result in a smoother newborn transition at birth and less bradycardia.…”

Neonatal resuscitation practices in Uganda: a video observational study

“…24 However, failing to initiate proper ventilation within the first minute and applying suboptimal PPV are also common in high-resource settings. [25][26][27] Specifically, a study from a tertiary hospital in Norway reports a median time from arriving to the table to initiation of PPV of 42 s and 56% of neonates received PPV, with a 60% ventilation fraction during the first 30 s. 25 The time to initiation of PPV was considerably longer in our study and does not commence within the recommended golden minute after birth. However, primarily due to logistical reasons, the time from birth to resuscitation was significantly longer for neonates in the labour ward.…”