Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway,
Department of Clinical Science, University of Bergen, Bergen, Norway,
Neonatology. 2020;117(2):175-181. doi: 10.1159/000506772. Epub 2020 Apr 3.
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.
In this prospective observational study, we video recorded resuscitations of newborns ≥34 weeks of gestation receiving PPV at birth.
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).
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.
新生儿复苏指南建议，在无呼吸新生儿出生后 60 秒内进行心率（HR）初始评估并开始正压通气（PPV）。脉搏血氧仪（PO）和心电图（ECG）是复苏过程中连续 HR 监测的推荐方法。我们的目的是评估指南的依从性以及 PO 与 ECG 监测在真实新生儿复苏中的效果。
在这项前瞻性观察研究中，我们对接受出生时 PPV 的胎龄≥34 周的新生儿复苏进行视频记录。
分析了 104 次复苏。从出生到到达复苏室的中位数（IQR）时间为 48（22-68）s（n=62），初始 HR 评估时间为 70（47-118）s（n=61），开始 PPV 的时间为 78（42-118）s（n=62）。初始 HR 评估（听诊或触诊）和开始 PPV 在 60 秒内完成的新生儿占 35%。阴道分娩后初始 HR 评估和开始 PPV 的时间明显长于剖宫产：84（70-139）与 44（30-66）s（p＜0.001）和 93（73-139）与 38（30-66）s（p＜0.001）。从出生到传感器应用到 PO 与 ECG 提供可靠 HR 信号的时间分别为 348（217-524）（n=42）与 174（105-277）s（n=30）（p＜0.001）和 199（77-352）（n=65）与 16（11-22）s（n=52）（p＜0.001）。
只有 1/3 的新生儿复苏在出生后 60 秒内完成初始 HR 评估和开始 PPV。在真实的复苏中，当用于连续 HR 监测时，ECG 在获得可靠 HR 信号的时间上优于 PO。
