Avoiding delivery room intubation (DRI) and stabilization of preterm infants on continuous positive airway pressure (CPAP) reduces death and bronchopulmonary dysplasia (BPD). 1-3 The Neonatal Resuscitation Program (NRP) suggests that spontaneously breathing preterm infants with respiratory distress may be supported with CPAP. 4 However, the majority of extremely low gestational age (GA) neonates receive face mask positive pressure ventilation (Fm-PPV) in the delivery room (DR). 5-7 Inadequate Fm-PPV during these crucial initial minutes after birth may result in persistent hypoxia and bradycardia, necessitating emergent intubation. Airway obstruction 8-10 and mask leak 9, 10 are common during Fm-PPV. The NRP recommends certain steps (mask seal, repositioning head, suction, open mouth, and increase pressure [MRSOP]) to optimize Fm-PPV before resorting to intubation. 11, 12 In addition, the use of colorimetric end-tidal

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.

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