Comparison of Two Techniques for Determining the Presence of a Pulse in an Infant

Neonatal resuscitation in low-resource settings: What, who, and how to overcome challenges to scale up?

“…The WHO guide does not include chest compressions in basic resuscitation unless the baby has persistent bradycardia “despite adequate ventilation,” and as long as two trained providers are present and the heart rate has been “assessed correctly” [3]. There are 4 arguments to support omission of chest compressions, at least for first-level facilities and community level: chest compressions are not necessary for the majority of babies who will survive [1,9], suggesting that the focus should be on ensuring effective ventilation;a second trained person to perform chest compression while the baby is ventilated is frequently unavailable in low-resource settings;studies have shown that even skilled personnel are often inaccurate in assessing the heart rate/pulse of newborns [41]; hence, a lesser skilled practitioner under stress may be considerably less able to assess heart rate and make correct decisions; andbabies who require chest compressions often require ongoing intensive care support post resuscitation—a level of care not available at first-level facilities or at many referral facilities in low-income settings.…”

“…studies have shown that even skilled personnel are often inaccurate in assessing the heart rate/pulse of newborns [41]; hence, a lesser skilled practitioner under stress may be considerably less able to assess heart rate and make correct decisions; and…”

Part 10: Pediatric Basic and Advanced Life Support

“…Thirteen LOE 5 studies 31–43 observed that neither laypersons nor healthcare providers are able to perform an accurate pulse check in healthy adults or infants within 10 seconds. In 2 LOE 5 studies in adults 44,45 and 2 LOE 3 studies in children with nonpulsatile circulation, 46,47 blinded healthcare providers commonly assessed pulse status inaccurately and their assessment often took >10 seconds.…”