Abstract
Background
Although electrocardiogram (ECG) can detect heart rate (HR) faster compared to pulse oximetry, it remains unknown if routine use of ECG for delivery room (DR) resuscitation reduces the time to stabilization in preterm infants.
Methods
Neonates <31 weeks’ gestation were randomized to either an ECG-displayed or an ECG-blinded HR assessment in the DR. HR, oxygen saturation, resuscitation interventions, and clinical outcomes were compared.
Results
During the study period, 51 neonates were enrolled. The mean gestational age in both groups was 28 ± 2 weeks. The time to stabilization, defined as the time from birth to achieve HR ≥100 b.p.m., as well as oxygen saturation within goal range, was not different between the ECG-displayed and the ECG-blinded groups [360 (269, 435) vs 345 (240, 475) s, p = 1.00]. There was also no difference in the time to HR ≥100 b.p.m. [100 (75, 228) vs 138 (88, 220) s, p = 0.40] or duration of positive pressure ventilation (PPV) [345 (120, 558) vs 196 (150, 273) s, p = 0.36]. Clinical outcomes were also similar between groups.
Conclusions
Although feasible and safe, the use of ECG in the DR during preterm resuscitation did not reduce time to stabilization.
Impact
-
Although feasible and apparently safe, routine use of the ECG in the DR did not decrease time to HR >100 b.p.m., time to stabilization, or use of resuscitation interventions such as PPV for preterm infants <31 weeks’ gestational age.
-
This article adds to the limited randomized controlled trial evidence regarding the impact of routine use of ECG during preterm resuscitation on DR clinical outcomes.
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Such evidence is important when considering recommendations for routine use of the ECG in the DR worldwide as such a recommendation comes with a significant cost burden.
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Change history
17 December 2021
A Correction to this paper has been published: https://doi.org/10.1038/s41390-021-01835-6
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V.K. acknowledges support by K23HD083511 grant from the NIH.
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All authors made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data, and critical revisions for important intellectual content. N.V.A. wrote the first draft of the manuscript. All authors approved the final version of the manuscript as submitted.
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Abbey, N.V., Mashruwala, V., Weydig, H.M. et al. Electrocardiogram for heart rate evaluation during preterm resuscitation at birth: a randomized trial. Pediatr Res 91, 1445–1451 (2022). https://doi.org/10.1038/s41390-021-01731-z
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DOI: https://doi.org/10.1038/s41390-021-01731-z
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