Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Parkland Health and Hospital System, Dallas, TX, USA.
Pediatr Res. 2022 May;91(6):1445-1451. doi: 10.1038/s41390-021-01731-z. Epub 2021 Oct 13.
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.
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.
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.
Although feasible and safe, the use of ECG in the DR during preterm resuscitation did not reduce time to stabilization.
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. 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.
虽然心电图（ECG）比脉搏血氧饱和度仪更快地检测心率（HR），但尚不清楚在产房（DR）复苏中常规使用 ECG 是否会缩短早产儿的稳定时间。
将胎龄<31 周的新生儿随机分为 DR 中显示 ECG 或 ECG 盲 HR 评估。比较 HR、氧饱和度、复苏干预和临床结局。
在研究期间，共纳入 51 例新生儿。两组的平均胎龄均为 28±2 周。从出生到达到 HR≥100 b.p.m.以及达到目标范围内的氧饱和度的稳定时间，在显示 ECG 组和 ECG 盲组之间没有差异[360（269，435）与 345（240，475）s，p=1.00]。达到 HR≥100 b.p.m.的时间也没有差异[100（75，228）与 138（88，220）s，p=0.40]或正压通气（PPV）持续时间[345（120，558）与 196（150，273）s，p=0.36]。两组的临床结局也相似。
尽管可行且安全，但在 DR 中使用 ECG 进行早产儿复苏并未缩短稳定时间。
尽管可行且显然安全，但在 DR 中常规使用 ECG 并不能缩短 HR>100 b.p.m.、稳定时间或使用复苏干预（如对胎龄<31 周的早产儿进行 PPV）的时间。本文增加了关于在 DR 中常规使用 ECG 对早产儿复苏临床结局影响的有限随机对照试验证据。当考虑在全球范围内推荐在 DR 中常规使用 ECG 时，这种证据很重要，因为这种建议会带来重大的成本负担。
