Rettedal Siren, Kibsgaard Amalie, Buskov Frederikke, Eilevstjønn Joar, Kolstad Vilde, Kvaløy Jan Terje, Bjorland Peder Aleksander, Pike Hanne, Haynes Joanna, Tysland Thomas Bailey, Davis Peter G, Ersdal Hege
Department of Simulation-Based Learning, Stavanger University Hospital, 4068 Stavanger, Norway.
Faculty of Health Sciences, University of Stavanger, 4036 Stavanger, Norway.
Children (Basel). 2025 Aug 18;12(8):1082. doi: 10.3390/children12081082.
BACKGROUND/OBJECTIVES: Newborn heart rate is an integral part of resuscitation algorithms, but the impact of ECG monitoring on resuscitative interventions and clinical outcomes has been identified as a knowledge gap. The objective was to evaluate the impact of routine use of dry-electrode ECG in all newborns immediately after birth on time to start positive pressure ventilation (PPV) when indicated.
We conducted a randomized clinical trial from June 2019 to November 2021 at Stavanger University Hospital, Norway. Dry-electrode ECG sensors were applied immediately after birth to all newborns ≥ 34 weeks' gestation. Randomization determined whether the heart rate display was visible or masked. Time of birth was registered in an observation app. Time to start ventilation was calculated from video recordings.
In total, 7343 newborns ≥ 34 weeks' gestation were enrolled, 4284 in the intervention and 3059 in the control group, and 3.7% and 3.8% received ventilation, respectively. In 171/275 (62%) of the newborns the exact time of birth and a video of the resuscitation were available, for 98 in the intervention and 73 in the control group. Ventilation was provided within 60 s to 44/98 (45%) in the intervention and 24/73 (33%) in the control group, = 0.12. Time from birth to start of PPV was a median of 66 (44, 102) s in the intervention and 84 (49, 148) s in the control group, = 0.058. Resuscitated newborns were apneic (74%) or breathing ineffectively (26%) at the start of PPV, and only 36% had a heart rate < 100 beats per minute.
The use of dry-electrode ECG heart rate monitoring did not change the proportion of newborns that received ventilation within 60 s after birth, but early termination due to employee protests to video recordings rendered the trial inadequately powered to detect a difference. Breathing status was likely a more important determinant of starting ventilation than bradycardia.
背景/目的：新生儿心率是复苏算法的一个重要组成部分，但心电图监测对复苏干预措施和临床结局的影响被认为是一个知识空白。目的是评估出生后立即对所有新生儿常规使用干电极心电图对在有指征时开始正压通气（PPV）的时间的影响。
我们于2019年6月至2021年11月在挪威斯塔万格大学医院进行了一项随机临床试验。对所有孕周≥34周的新生儿在出生后立即应用干电极心电图传感器。随机分组决定心率显示是否可见。出生时间在一个观察应用程序中记录。开始通气的时间从视频记录中计算得出。
总共纳入了7343例孕周≥34周 的新生儿，干预组4284例，对照组3059例，分别有3.7%和3.8%接受了通气。在171/275（62%）的新生儿中可获得确切的出生时间和复苏视频，干预组98例，对照组73例。干预组44/98（45%）、对照组24/73（33%）在60秒内进行了通气，P = 0.12。从出生到开始PPV的时间在干预组中位数为66（44，102）秒，在对照组为84（49，148）秒，P = 0.058。接受复苏的新生儿在开始PPV时出现呼吸暂停（74%）或呼吸无效（26%），只有36%的新生儿心率<100次/分钟。
使用干电极心电图心率监测并未改变出生后60秒内接受通气的新生儿比例，但由于员工对视频记录的抗议导致试验提前终止，使得该试验检测差异的效能不足。呼吸状态可能是比心动过缓更重要的开始通气的决定因素。
