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Kapadia VS, Kawakami MD, Strand ML, Gately C, Spencer A, Schmölzer GM, Rabi Y, Wylie J, Weiner G, Liley HG, Wyckoff MH. Newborn heart rate monitoring methods at birth and clinical outcomes: A systematic review. Resusc Plus 2024; 19:100665. [PMID: 38974929 PMCID: PMC11225902 DOI: 10.1016/j.resplu.2024.100665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 07/09/2024] Open
Abstract
Aim Compare heart rate assessment methods in the delivery room on newborn clinical outcomes. Methods A search of Medline, SCOPUS, CINAHL and Cochrane was conducted between January 1, 1946, to until August 16, 2023. (CRD 42021283438) Study Selection was based on predetermined criteria. Reviewers independently extracted data, appraised risk of bias and assessed certainty of evidence. Results Two randomized controlled trials involving 91 newborns and 1 nonrandomized study involving 632 newborns comparing electrocardiogram (ECG) to auscultation plus pulse oximetry were included. No studies were found that compared any other heart rate measurement methods and reported clinical outcomes. There was no difference between the ECG and control group for duration of positive pressure ventilation, time to heart rate ≥ 100 beats per minute, epinephrine use or death before discharge. In the randomized studies, there was no difference in rate of tracheal intubation [RR 1.34, 95% CI (0.69-2.59)]. No participants received chest compressions. In the nonrandomized study, fewer infants were intubated in the ECG group [RR 0.75, 95% CI (0.62-0.90)]; however, for chest compressions, benefit or harm could not be excluded. [RR 2.14, 95% (CI 0.98-4.70)]. Conclusion There is insufficient evidence to ascertain clinical benefits or harms associated with the use of ECG versus pulse oximetry plus auscultation for heart rate assessment in newborns in the delivery room.
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Affiliation(s)
- Vishal S. Kapadia
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | | | | | | | | | | | - Yacov Rabi
- University of Calgary, Calgary, Alberta, Canada
| | - Johnathan Wylie
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - Gary Weiner
- University of Michigan, Ann Arbor, MI 48109, United States
| | | | - Myra H. Wyckoff
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - International Liaison Committee on Resuscitation Neonatal Life Support Task Force
- University of Texas Southwestern Medical Center, Dallas, TX, United States
- Federal University of Sao Paulo, Sao Paulo, Brazil
- Akron Children’s Hospital, Akron, OH, United States
- University of Otago, Wellington, New Zealand
- Saint Louis University, St. Louis, MO, United States
- University of Alberta, Edmonton, Alberta, Canada
- University of Calgary, Calgary, Alberta, Canada
- James Cook University Hospital, Middlesbrough, United Kingdom
- University of Michigan, Ann Arbor, MI 48109, United States
- University of Queensland, Australia
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Weiner GM, Zaichkin J. Updates for the Neonatal Resuscitation Program and Resuscitation Guidelines. Neoreviews 2022; 23:e238-e249. [PMID: 35362042 DOI: 10.1542/neo.23-4-e238] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Although most newborns require no assistance to successfully transition to extrauterine life, the large number of births each year and limited ability to predict which newborns will need assistance means that skilled clinicians must be prepared to respond quickly and efficiently for every birth. A successful outcome is dependent on a rapid response from skilled staff who have mastered the cognitive, technical, and behavioral skills of neonatal resuscitation. Since its release in 1987, over 4.5 million clinicians have been trained by the American Heart Association and American Academy of Pediatrics Neonatal Resuscitation Program®. The guidelines used to develop this program were updated in 2020 and the Textbook of Neonatal Resuscitation, 8th edition, was released in June 2021. The updated guidelines have not changed the basic approach to neonatal resuscitation, which emphasizes the importance of anticipation, preparation, teamwork, and effective ventilation. Several practices have changed, including the prebirth questions, initial steps, use of electronic cardiac monitors, the initial dose of epinephrine, the flush volume after intravascular epinephrine, and the duration of resuscitation with an absent heart rate. In addition, the program has enhanced components of the textbook to improve learning, added new course delivery options, and offers 2 course levels to allow learners to study the material that is most relevant to their role during neonatal resuscitation. This review summarizes the recent changes to the resuscitation guidelines, the textbook, and the Neonatal Resuscitation Program course.
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Affiliation(s)
- Gary M Weiner
- Department of Pediatrics, Neonatal-Perinatal Medicine, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
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Neonatal resuscitation: current evidence and guidelines. BJA Educ 2021; 21:479-485. [PMID: 34840820 DOI: 10.1016/j.bjae.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/21/2022] Open
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Bush JB, Cooley V, Perlman J, Chang C. NeoBeat offers rapid newborn heart rate assessment. Arch Dis Child Fetal Neonatal Ed 2021; 106:550-552. [PMID: 33478958 DOI: 10.1136/archdischild-2020-320901] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/04/2020] [Accepted: 12/29/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Heart rate (HR) is used to guide interventions during delivery room (DR) neonatal resuscitation. Dry electrode ECG (NeoBeat) may detect HR more rapidly than pulse oximetry (PO) and portable ECG, but real-time comparisons of these devices are lacking. DESIGN/METHODS PO, ECG and NeoBeat were placed sequentially on newborns in the DR. Time for device placement and time to accurate HR acquisition were noted. RESULTS DR resuscitations of 28 preterm/term infants were observed. The NeoBeat was placed faster (ie, 3 s) than PO (20 s, p=<0.0001) and ECG (16 s, p=<0.0001). Total time from initiation of device placement to HR acquisition was fastest with NeoBeat (13 s) versus ECG (42 s, p<0.0001) and PO (105 s, p<0.0001) (duration values=median). CONCLUSIONS These observations in a small cohort of relatively well neonates demonstrate that the NeoBeat is significantly faster to place and consistently acquires HR faster than PO and ECG.
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Affiliation(s)
- Jessica Brittany Bush
- Department of Pediatrics, New York Presbyterian Hospital - Weill Cornell Medicine, New York, New York, USA
| | - Victoria Cooley
- Department of Population Health Sciences, New York Presbyterian Weill Cornell, New York, New York, USA
| | - Jeffrey Perlman
- Department of Population Health Sciences, New York Presbyterian Weill Cornell, New York, New York, USA
| | - Catherine Chang
- Department of Population Health Sciences, New York Presbyterian Weill Cornell, New York, New York, USA
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Foglia EE, Weiner G, de Almeida MFB, Wyllie J, Wyckoff MH, Rabi Y, Guinsburg R. Duration of Resuscitation at Birth, Mortality, and Neurodevelopment: A Systematic Review. Pediatrics 2020; 146:peds.2020-1449. [PMID: 32788267 DOI: 10.1542/peds.2020-1449] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The International Liaison Committee on Resuscitation Neonatal Life Support Task Force reviewed evidence for the duration of cardiopulmonary resuscitation (CPR) for newborns immediately after birth. OBJECTIVE To summarize evidence for ongoing CPR on the outcomes of survival, neurodevelopment, and the composite of survival without moderate or severe neurodevelopmental impairment (NDI). DATA SOURCES Medline, Embase, Evidence-Based Medicine Reviews, Cumulative Index to Nursing and Allied Health Literature, and Scientific Electronic Library Online were searched between inception and February 29, 2020. STUDY SELECTION Two independent reviewers selected studies of newborns with at least 10 minutes of asystole, bradycardia, or pulseless electrical activity for which CPR is indicated. DATA EXTRACTION Two independent reviewers extracted data and appraised the risk of bias. RESULTS In 16 eligible studies, researchers reported outcomes of 579 newborns born between 1982 and 2017. Within individual studies, 2% to 100% of infants survived to last follow-up (hospital discharge through 12 years). Summarized across studies, 237 of 579 (40.9%) newborns survived to last follow-up. In 13 studies, researchers reported neurodevelopmental outcomes of 277 newborns. Of these, 30 of 277 (10.8%) survived without moderate or severe impairment, and 240 of 277 (87%) met the composite outcome of death or NDI (191 died and 49 survived with moderate or severe impairment). LIMITATIONS There was very low certainty of evidence because of risk of bias and inconsistency. CONCLUSIONS Infants with ongoing CPR at 10 minutes after birth are at high risk for mortality and neurodisability, but survival without moderate or severe NDI is possible. One specified duration of CPR is unlikely to uniformly predict survival or survival without neuroimpairment.
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Affiliation(s)
- Elizabeth E Foglia
- Division of Neonatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
| | - Gary Weiner
- Division of Neonatal-Perinatal Medicine, C.S. Mott Children's Hospital and University of Michigan, Ann Arbor, Michigan
| | - Maria Fernanda B de Almeida
- Division of Neonatal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jonathan Wyllie
- Departments of Paediatrics and Neonatology, The James Cook University Hospital, South Tees Hospitals National Health Services Foundation Trust, Middlesbrough, United Kingdom
| | - Myra H Wyckoff
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Yacov Rabi
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Ruth Guinsburg
- Division of Neonatal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Heart Rate Assessment during Neonatal Resuscitation. Healthcare (Basel) 2020; 8:healthcare8010043. [PMID: 32102255 PMCID: PMC7151423 DOI: 10.3390/healthcare8010043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/07/2020] [Accepted: 02/19/2020] [Indexed: 12/02/2022] Open
Abstract
Approximately 10% of newborn infants require some form of respiratory support to successfully complete the fetal-to-neonatal transition. Heart rate (HR) determination is essential at birth to assess a newborn’s wellbeing. Not only is it the most sensitive indicator to guide interventions during neonatal resuscitation, it is also valuable for assessing the infant’s clinical status. As such, HR assessment is a key step at birth and throughout resuscitation, according to recommendations by the Neonatal Resuscitation Program algorithm. It is essential that HR is accurate, reliable, and fast to ensure interventions are delivered without delay and not prolonged. Ineffective HR assessment significantly increases the risk of hypoxic injury and infant mortality. The aims of this review are to summarize current practice, recommended techniques, novel technologies, and considerations for HR assessment during neonatal resuscitation at birth.
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Bjorland PA, Ersdal HL, Øymar K, Rettedal SI. Compliance with Guidelines and Efficacy of Heart Rate Monitoring during Newborn Resuscitation: A Prospective Video Study. Neonatology 2020; 117:175-181. [PMID: 32248187 PMCID: PMC9533428 DOI: 10.1159/000506772] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/24/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Newborn resuscitation guidelines recommend initial assessment of heart rate (HR) and initiation of positive pressure ventilation (PPV) within 60 s after birth in non-breathing newborns. Pulse oximeter (PO) and electrocardiogram (ECG) are suggested methods for continuous HR monitoring during resuscitation. Our aim was to evaluate compliance with guidelines and the efficacy of PO versus ECG monitoring in real-life newborn resuscitations. METHODS In this prospective observational study, we video recorded resuscitations of newborns ≥34 weeks of gestation receiving PPV at birth. RESULTS 104 resuscitations were analysed. Median (IQR) time from birth to arrival at the resuscitation bay was 48 (22-68) s (n = 62), to initial HR assessment 70 (47-118) s (n = 61), and to initiation of PPV 78 (42-118) s (n = 62). Initial HR assessment (stethoscope or palpation) and initiation of PPV were achieved within 60 s for 35% of the resuscitated newborns. Time to initial HR assessment and initiating PPV was significantly longer following vaginal deliveries than caesarean sections: 84 (70-139) versus 44 (30-66) s (p < 0.001) and 93 (73-139) versus 38 (30-66) s (p < 0.001). Time from birth and sensor application to provision of a reliable HR signal from PO versus ECG was 348 (217-524) (n = 42) versus 174 (105-277) s (n = 30) (p < 0.001) and 199 (77-352) (n = 65) versus 16 (11-22) s (n = 52) (p < 0.001). CONCLUSION Initial HR assessment and initiation of PPV were achieved within 60 s after birth in only 1/3 of newborn resuscitations. When applied for continuous HR monitoring, ECG was superior to PO in time to achieve reliable HR signals in real-life resuscitations.
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Affiliation(s)
- Peder Aleksander Bjorland
- Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway, .,Department of Clinical Science, University of Bergen, Bergen, Norway,
| | - Hege Langli Ersdal
- Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Knut Øymar
- Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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Luong D, Cheung PY, Barrington KJ, Davis PG, Unrau J, Dakshinamurti S, Schmölzer GM. Cardiac arrest with pulseless electrical activity rhythm in newborn infants: a case series. Arch Dis Child Fetal Neonatal Ed 2019; 104:F572-F574. [PMID: 30796058 DOI: 10.1136/archdischild-2018-316087] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/21/2019] [Accepted: 02/03/2019] [Indexed: 11/03/2022]
Abstract
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.
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Affiliation(s)
- Deandra Luong
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Po-Yin Cheung
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Keith J Barrington
- Department of Neonatology, Centre Hospitalier Universitaire Sainte Justine, Montreal, Quebec, Canada
| | - Peter G Davis
- Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Jennifer Unrau
- Department of Neonatology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Georg M Schmölzer
- Department of Neonatology, Royal Alexandra Hospital, Edmonoton, Alberta, Canada
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Impact of electronic cardiac (ECG) monitoring on delivery room resuscitation and neonatal outcomes. Resuscitation 2019; 143:10-16. [DOI: 10.1016/j.resuscitation.2019.07.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/14/2019] [Accepted: 07/29/2019] [Indexed: 11/23/2022]
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