Oxygen saturation after birth in resuscitated neonates in Uganda: a video-based observational study

Abstract

BackgroundMonitoring of peripheral capillary oxygen saturation (SpO2) during neonatal resuscitation is standard of care in high-resource settings, but seldom performed in low-resource settings. We aimed to measure SpO2 and heart rate during the first 10 min of life in neonates receiving positive pressure ventilation (PPV) according to the Helping Babies Breathe (HBB) protocol and compare results with SpO2 and heart rate targets set by the American Heart Association (AHA).MethodsA cross-sectional study was conducted at Mulago National Referral Hospital, Kampala, Uganda, as a substudy of the NeoSupra Trial. SpO2 and heart rate were measured on apnoeic neonates (≥34 weeks) who received PPV according to HBB (room air). Those who remained distressed after PPV received supplemental oxygen (O2). All resuscitations were video recorded and data were extracted by video review at 1 min intervals until 10 min post partum. Data were analysed for all observations and separately for only observations before and during PPV.Results49 neonates were analysed. Median SpO2 at 5 min (n=39) was 67% (49–88) with 59% of the observations below AHA target of 80%. At 10 min median SpO2 (n=44) was 93% (80–97) and 32% were below AHA target of 85%. When only observations before and during PPV were analysed, median SpO2 at 5 min (n=18) was 52% (34–66) and 83% were below AHA target. At 10 min (n=15), median SpO2 was 72% (57–89) and 67% were below AHA target. Median heart rates were above AHA target of 100 beats/min at all time intervals.ConclusionsA high proportion of neonates resuscitated with PPV after birth failed to reach the AHA SpO2 target in this small sample, implying an increased risk of hypoxic-ischaemic encephalopathy. Further studies in low-resource settings are needed to evaluate baseline data and the need for supplemental O2 and optimal SpO2 during PPV.Trial registration numberThis is a substudy to the trial ‘Neonatal Resuscitation with Supraglottic Airway Trial (NeoSupra)’; ClinicalTrials.gov Registry (NCT03133572).

Neonatal resuscitation monitoring: A low-cost video recording setup for quality improvement in the delivery room at the resuscitation table

“…Video recording for data documentation during neonatal resuscitation is increasingly regarded as a golden standard of practice. Both our own ( 19 , 20 , 29 , 30 ) and other ( 6 , 21 , 22 , 27 , 35 , 40 ) research teams have previously conducted similar studies. Usage of video recording, heart rate monitoring, and NeoTapAS in these studies were useful tools to identify performance at the resuscitation table ( 17 , 19 , 20 , 28 – 31 , 33 , 41 ) and improve data collection.…”

“…When reviewing the videos, we saw that the ventilation times were inaccurate and could not use the data in the first published paper ( 31 ). In a recent sub-study ( 29 ), ventilation time was recorded by looking at the videos and recording the time of start and stop of ventilation. A comparison of ventilation time from the case report forms and this method is noted in Table 1 .…”

“…NeoBeat heart rate meters were installed for a sub-study, and therefore only used for part of the newborns. It was placed directly around the neonates’ abdomen, providing a fast and accurate continuous display of heart rate visible on the videos during the review process ( 29 ). Inclusion criteria were neonates born in the hospital, estimated gestational age of at least 34 weeks, estimated birth weight of at least 2,000 g, and need of PPV at birth.…”