Electrocardiogram shows reliable heart rates much earlier than pulse oximetry during neonatal resuscitation

Abstract

ECG was a safe and reliable method for showing HR, and was used to determine the initiation and the effectiveness of resuscitation in the delivery room.

Part 13: Neonatal Resuscitation

“…3 The 2015 ILCOR systematic review evaluated 1 study comparing clinical assessment with electrocardiography (ECG) in the delivery room 117 and 5 studies comparing simultaneous pulse oximetry and ECG. [118][119][120][121][122] Clinical assessment was found to be both unreliable and inaccurate. Among healthy newborns, providers frequently could not palpate the umbilical pulse and underestimated the newborn's heart rate by auscultation or palpation.…”

Part 7: Neonatal Resuscitation

“…For the important outcomes of fast and accurate measurement of heart rate in babies requiring resuscitation, we have identified Very-low-quality evidence from 5 nonrandomized studies enrolling 213 patients showing a benefit of ECG compared with oximetry [19][20][21][22][23] Very-low-quality evidence from 1 nonrandomized study enrolling 26 patients showing a benefit of ECG compared with auscultation 24 The available evidence is from nonrandomized studies, downgraded for indirectness and imprecision.…”

Part 13: Neonatal Resuscitation

“…[118][119][120][121][122] Clinical assessment was found to be both unreliable and inaccurate. Among healthy newborns, providers frequently could not palpate the umbilical pulse and underestimated the newborn' s heart rate by auscultation or palpation.…”

“…118,[120][121][122] In 2 studies, ECG was more likely to detect the newborn' s heart rate during the first minute of life. 120,121 Although the mean differences between the series of heart rates measured by ECG and pulse oximetry were small, pulse oximetry tended to underestimate the newborn' s heart rate and would have led to potentially unnecessary interventions. 118,119,122 During the first 2 minutes of life, pulse oximetry frequently displayed the newborn' s heart rate below either 60/min or 100/min, while a simultaneous ECG showed the heart rate greater than 100/min.…”