Electrocardiogram for heart rate evaluation during preterm resuscitation at birth: a randomized trial

Abstract

Background Although electrocardiogram (ECG) can detect heart rate (HR) faster compared to pulse oximetry, it remains unknown if routine use of ECG for delivery room (DR) resuscitation reduces the time to stabilization in preterm infants. Methods Neonates <31 weeks’ gestation were randomized to either an ECG-displayed or an ECG-blinded HR assessment in the DR. HR, oxygen saturation, resuscitation interventions, and clinical outcomes were compared. Results During the study period, 51 neonates were enrolled. The mean gestational age in both groups was 28 ± 2 weeks. The time to stabilization, defined as the time from birth to achieve HR ≥100 b.p.m., as well as oxygen saturation within goal range, was not different between the ECG-displayed and the ECG-blinded groups [360 (269, 435) vs 345 (240, 475) s, p = 1.00]. There was also no difference in the time to HR ≥100 b.p.m. [100 (75, 228) vs 138 (88, 220) s, p = 0.40] or duration of positive pressure ventilation (PPV) [345 (120, 558) vs 196 (150, 273) s, p = 0.36]. Clinical outcomes were also similar between groups. Conclusions Although feasible and safe, the use of ECG in the DR during preterm resuscitation did not reduce time to stabilization. Impact Although feasible and apparently safe, routine use of the ECG in the DR did not decrease time to HR >100 b.p.m., time to stabilization, or use of resuscitation interventions such as PPV for preterm infants <31 weeks’ gestational age. This article adds to the limited randomized controlled trial evidence regarding the impact of routine use of ECG during preterm resuscitation on DR clinical outcomes. Such evidence is important when considering recommendations for routine use of the ECG in the DR worldwide as such a recommendation comes with a significant cost burden.

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

“…It may take up to a minute to have reliable pulse oximetry readings for HR and SpO 2 . Heart rate can be rapidly counted by auscultation, which is not as accurate as oximetry or ECG [57]; however, it is not clear whether rapid ECG-derived HR signal confers any meaningful clinical benefit [58]. Caregivers are quite capable of determin-ing when HR <60 or above 100 bpm which is all that is needed [59].…”

2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

“…The only exception was a lower proportion of infants intubated in the delivery room in an observational study when electrocardiographic monitoring was used, 219 a result that was not confirmed in the meta-analysis of 2 RCTs. 217,218 The potential advantages of rapid signal acquisition and continuous, accurate heart rate monitoring need to be weighed against the potential costs of equipment and training.…”

“…The SysRev identified 2 RCTs 217,218 involving 91 newborn infants and 1 cohort study 219 involving 632 newborn infants.…”

Race and Ethnicity of Infants Enrolled in Neonatal Clinical Trials

“…We identified 120 studies that were entered into Cochrane CENTRAL 2017 to 2021 and met our inclusion criteria (eFigure 1 in Supplement 1). There was a range in the articles’ availability via electronic publication (2016-2021) and publication year (2017-2023).…”

“…Figure 1 shows that the distribution of reporting vs not reporting race and ethnicity data in NICU clinical studies over the 5 years evaluated. We assessed reporting by NIH funding: of the 52 studies funded by the NIH, 35 studies (67%) included race and ethnicity data. Among 68 studies not funded by the NIH, 40 studies (58%) reported race and ethnicity data; the difference between NIH-funded and non-NIH–funded studies was not statistically significant by Pearson χ 2 .…”