A comparative evaluation of portable Doppler ultrasound versus electrocardiogram in heart-rate accuracy and acquisition time immediately after delivery: a multicenter observational study

Amplification of Heart Sounds Using Digital Stethoscope in Simulation-Based Neonatal Resuscitation

OBJECTIVE

The accuracy, timeliness, and reliability of the current methods of heart rate (HR) determination in neonatal resuscitation are debatable, each having its own limitations. We aim to compare three methods of HR assessment: (1) traditional stethoscope, (2) electrocardiogram and traditional stethoscope, and (3) digital stethoscope with loudspeaker amplification of heart sounds.

STUDY DESIGN

This was a simulated crossover experiment using a high-fidelity manikin. Each team with a physician, a nurse, and a respiratory therapist performed the resuscitations using the three methods (three different scenarios) in different order. The person controlling the HR via manikin controller was blinded, but the single recorder and the providers were not.

RESULTS

Eighteen resuscitations were completed (six teams of three methods each). The time to first HR recording (p < 0.001), total number of HR recorded (p < 0.001), and time to recognize dips in HR was significantly improved in the digital stethoscope group (p = 0.009).

CONCLUSION

Use of digital stethoscope with amplification improved documentation of HR and earlier recognition of HR changes.

KEY POINTS

· Amplified heartbeats during neonatal resuscitation improved documentation.. · Amplified infant heartbeats resulted in earlier recognition of HR changes (increase or decrease).. · Providers using this method had greater satisfaction..

The Use of Foetal Doppler Ultrasound to Determine the Neonatal Heart Rate Immediately after Birth: A Systematic Review

Determining the neonatal heart rate immediately after birth is unsatisfactory. Auscultation is inaccurate and provides no documented results. The use of foetal Doppler ultrasound has been recognised as a possible method of determining the neonatal heart rate after birth over the last nine years. This review includes all published studies of this approach, looking at accuracy, speed of results, and practical application of the approach. Precordial Doppler ultrasound has been shown to be as accurate as ECG and more accurate than oximetry for the neonatal heart rate, and provides quicker results than either ECG or oximetry. There is the potential for a much improved determination and documentation of the neonatal heart rate using this approach.

Delivery room ultrasound study to assess heart rate in newborns: DELIROUS study

During neonatal resuscitation in the delivery room, heart rate guides clinical intervention, and although different methods have been evaluated as auscultation, pulse oximetry, and electrocardiography, they have various limitations. This was a prospective observational study which aim was to evaluate the accuracy and speed of ultrasound for measuring neonatal heart rate compared with stethoscope, pulse oximetry, and electrocardiography. Simultaneous determinations of heart rate using stethoscope, ultrasound, pulse oximetry, and electrocardiography were performed. Fifty term newborns were included. There were no differences according to the turn on time of the ultrasound, pulse oximetry, and electrocardiography (p = 0.666), but the placement time and the detection time from birth were shorter for ultrasound (p < 0.001). A stronger positive correlation was detected between ultrasound and electrocardiography at 90 (Rho = 0.926), and 120 s (Rho = 0.920) with p < 0.001. The Bland-Altman analysis showed a bias of - 2.23 (p = 0.129) between ultrasound and electrocardiography at 90 s, and a bias of 0.44 (p = 0.092) at 120 s. Instead, the bias between auscultation and electrocardiography at 90 s was - 6.71 (p = 0.131), and at 120 s was of - 4.67 (p = 0.793).Conclusions: Ultrasound is a fast method to detect heart rate in the delivery room and has a good correlation with stethoscope and electrocardiography. What is Known: • During neonatal resuscitation in the delivery room, heart rate guides clinical intervention, and although different methods have been evaluated, they have various limitations. What is New: • Heart rate ultrasound is a good and fast method to detect HR in the delivery room with a good correlation with electrocardiography and stethoscope.

The Future of Cardiac Ultrasound in the Neonatal Intensive Care Unit

Cardiac ultrasound is increasingly used to guide hemodynamic decision making in the neonatal intensive care unit (NICU). This article focuses on likely future progress in training, accreditation, digital connectivity, miniaturization, and modality development. Many documents have been published internationally to guide cardiac ultrasound training, accreditation, and implementation in the NICU, but challenges remain in providing assessments of hemodynamic status without risking missed structural diagnoses. Advances in simulation training and digital connectivity provide an opportunity to standardize approaches across institutions and continents. Development of machine learning and ultrasound modalities in turn provide huge scope for improving robustness and completeness of assessment.

Doppler Ultrasound for Heart Rate Assessment in a Porcine Model of Neonatal Asphyxia

Objectives: Approximately 10% of newborn infants require resuscitation at birth. Accurate heart rate (HR) assessment guides resuscitation interventions, thereby reducing morbidities and mortality. While existing HR assessment methods have several limitations, the Doppler ultrasound (Doppler-US) might be a promising alternative. We aimed to evaluate accuracy and optimal use of Doppler-US for HR assessments during neonatal asphyxia in a pre-clinical model. Design: HR assessments were performed in 16 term newborn piglets that were anesthetized, intubated, and instrumented. Study I evaluated optimal transducer position, Study II compared aortic (AV) and pulmonary (PV) examination modes, and Study III examined accuracy during asphyxia, for HR assessment. Setting: Experimental setting. Subjects: Asphyxia-induced piglets. Interventions: Study I: Doppler-US (USCOM® 1A) HR was assessed on upper (A), middle (B), and lower (C) third of the sternum; study II: Doppler-US HR was assessed using AV and PV examination modes; study III: HR was assessed during asphyxia. Comparisons were made between Doppler-US and the clinical gold standard for HR assessments, electrocardiography (ECG). Measurements and Main Results: Study I: Mean (SD) Doppler-US HR at position A, B, and C showed no difference when compared to ECG HR. Study II: The mean (SD) Doppler-US HR using AV and PV modes also showed no difference when compared to ECG HR. Study III: Bland-Altman analysis revealed a mean difference (95% limits of agreement) between Doppler-US and ECG HR of 1.5 (-16 to 19) bpm. Additionally, motion artifacts produced false peaks and peak size was seen to decrease as bradycardia progressed. Conclusions: HR assessment using Doppler-US during asphyxia is accurate but has limitations and must be further evaluated prior to clinical use. Doppler-US can be positioned along the sternum and use either AV or PV mode for accurate assessments in a piglet model of neonatal asphyxia.