A randomised cross-over study of methods of acquiring ECG heart rate in newborns

The 2015 neonatal resuscitation guidelines added ECG to assess an infant’s heart rate when determining the need for resuscitation at birth. However, a recent case report raised concerns about this technique in the delivery room. We report four cases of pulseless electrical activity during neonatal cardiopulmonary resuscitation in levels II–III neonatal intensive care units in Canada (Edmonton [n=3] and Winnipeg [n=1]).Healthcare providers should be aware that pulseless electrical activity can occur in newborn infants during cardiopulmonary resuscitation. We propose an adapted neonatal resuscitation algorithm to include pulseless electrical activity. Furthermore, in compromised newborns, heart rate should be assessed using a combination of methods/techniques to ensure accurate heart rate assessment. When ECG displays a heart rate but the infant is unresponsive, pulseless electrical activity should be suspected and chest compression should be started.

Section: Discussionmentioning

confidence: 99%

Cardiac arrest with pulseless electrical activity rhythm in newborn infants: a case series

Luong

Cheung

Barrington

et al. 2019

“…For each infant, one of two investigators was randomly chosen to apply the monitors. When using the IntelliVue, the investigators applied the ECG before PO4 and connected the ECG leads to the monitor before applying them to the infant 5. When applying PO for both the IntelliVue and Nellcor, investigators applied the PO sensor to the infant before connecting it to the monitor 6.…”

Section: Methodsmentioning

confidence: 99%

Comparison of infant heart rate assessment by auscultation, ECG and oximetry in the delivery room

Murphy

Angelis²,

McCarthy

et al. 2018

Self Cite

Clinical assessment of an infant's heart rate (HR) in the delivery room (DR) has been reported to be inaccurate. We compared auscultation of the HR using a stethoscope with electrocardiography (ECG) and pulse oximetry (PO) for determining the HR in 92 low-risk newborn infants in the DR. Caregivers auscultated the HR while masked to the HR on the monitor. Auscultation underestimated ECG HR (mean difference (95% CI) by -9 (-15 to -2) beats per minute (bpm)) and PO HR (mean difference (95% CI) by -5 (-12 to 2) bpm). The median (IQR) time to HR by auscultation was 14 (10-18) s. As HR was determined quickly and with reasonable accuracy by auscultation in low-risk newborns, study in high-risk infants is warranted.

“…For infants monitored with IntelliVue, three ECG electrodes (Ambu WhiteSensor, Ambu A/S Ballerup, Denmark) were connected to the monitor before delivery, the chest was dried with a towel, and the electrodes applied before the PO sensor 8 9. When applying PO, the sensor (Masimo Neo LNOP) was applied to the infant’s right wrist before it was connected to the monitor 10 11.…”

Section: Interventionmentioning

confidence: 99%

Randomised study comparing heart rate measurement in newly born infants using a monitor incorporating electrocardiogram and pulse oximeter versus pulse oximeter alone

Murphy

Angelis

McCarthy

et al. 2018

Self Cite

AimTo determine whether IntelliVue (ECG plus Masimo pulse oximeter (PO)) measures heart rate (HR) in low-risk newborns more quickly than Nellcor PO (PO alone).MethodsUnmasked parallel group randomised (1:1) study.ResultsWe studied 100 infants, 47 randomised to IntelliVue, 53 to Nellcor. Time to first HR was shorter with IntelliVue ECG than Nellcor (median (IQR) 24 (19, 39) vs 48 (36, 69) s, p<0.001). There was no difference in time to display both HR and SpO2 (52 (47, 76) vs 48 (36, 69) s, p=0.507). IntelliVue PO displayed initial bradycardia more often than the Nellcor (55% vs 6%). Infants monitored with IntelliVue were handled more frequently and for longer.ConclusionsIntelliVue ECG displayed HR more quickly than Nellcor PO. IntelliVue PO often displayed initial bradycardia. Infants monitored with IntelliVue were handled more often. Study of ECG in high-risk infants is warranted.