Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Resuscitation. 2019 Oct;143:196-207. doi: 10.1016/j.resuscitation.2019.07.018. Epub 2019 Jul 19.
6.5-9 million newborns worldwide require resuscitation at birth annually. During neonatal resuscitation, inaccurate or slow heart rate (HR) assessments may significantly increase risk of infant mortality or morbidity. Therefore fast, accurate, and effective HR assessment tools are critical for neonatal resuscitation.
To systematically review the literature about accuracy, latency, and efficacy of technologies for HR assessment during neonatal resuscitation.
Adhering to PRISMA guidelines, PubMed, EMBASE, and Google Scholar databases were systematically searched to identify studies related to technologies for HR assessment, which could be used to guide neonatal resuscitation.
Forty-six studies evaluating HR assessment technologies for neonatal resuscitation were identified. In total, 16 studies (3/16 randomized trials and 13/16 observational studies) compared two or more HR assessment technologies to measure accuracy, latency, and efficacy. Of the trials, 1/3 had a low risk of bias while 2/3 had high risks. All observational studies had high risks of bias. Most studies considered infants not requiring resuscitation, constituting indirect evidence and lower certainty in the context of neonatal resuscitation. Two trials reported faster times to HR assessment using electrocardiogram with a mean(SD) 66(20) versus 114(39) s and a median(IQR) 24(19-39) versus 48(36-69) s (both p < 0.001), compared to pulse oximetry.
While electrocardiography is faster to assess HR at birth and more reliable to detect HR changes compared to other recommended technologies, practice should not exclusively rely on ECG. While novel technologies could support HR assessment, no studies validate their clinical efficacy during neonatal resuscitation.
全球每年有 650 万至 900 万新生儿需要在出生时进行复苏。在新生儿复苏过程中，不准确或缓慢的心率（HR）评估可能会显著增加婴儿死亡率或发病率的风险。因此，快速、准确、有效的 HR 评估工具对于新生儿复苏至关重要。
系统回顾关于新生儿复苏中 HR 评估技术的准确性、潜伏期和有效性的文献。
根据 PRISMA 指南，系统检索了 PubMed、EMBASE 和 Google Scholar 数据库，以确定与 HR 评估技术相关的研究，这些研究可用于指导新生儿复苏。
共确定了 46 项评估新生儿复苏中 HR 评估技术的研究。共有 16 项研究（3/16 为随机试验，13/16 为观察性研究）比较了两种或更多种 HR 评估技术以评估准确性、潜伏期和有效性。其中，1/3 的试验为低偏倚风险，而 2/3 的试验为高偏倚风险。所有观察性研究均具有高偏倚风险。大多数研究考虑了不需要复苏的婴儿，构成了间接证据，并且在新生儿复苏的背景下，证据确定性较低。有两项试验报告使用心电图进行 HR 评估的时间更快，平均（SD）为 66（20）与 114（39）s，中位数（IQR）为 24（19-39）与 48（36-69）s（均 p<0.001），与脉搏血氧仪相比。
虽然与其他推荐的技术相比，心电图在评估出生时的 HR 更快且更可靠地检测 HR 变化，但实践不应仅依赖于 ECG。虽然新技术可以支持 HR 评估，但没有研究验证它们在新生儿复苏期间的临床疗效。
