A randomized controlled trial of neonatal EKG

Neonatal EKG

Summary

A new study from Neonatal Research Institute Team in San Diego suggests that EKG provides an earlier, and more accurate heart rate than pulse rate from an oximeter during stabilization of preterm infants, allowing earlier intervention.

Neonatal EKG

The majority of newborn infants make the transition from the intrauterine to extrauterine environment successfully; however, approximately 10% of newborn infants require assistance during this transition. Current guidelines from the American Academy of Pediatrics (AAP) and the International Liaison Committee of Resuscitation (ILCOR) state the importance of heart rate (HR) as the most vital of vital signs during neonatal transition and/or resuscitation. In infants who are severely depressed at birth, continually updated heart rate provides caregivers the opportunity to respond to HR as it happens, rather than learning it the next time someone auscultates or palpates the heart rate.

Previous trials have shown that EKG heart rate is available before pulse rate from a pulse oximeter. To date no trial has looked at how the availability of electrocardiogram (EKG) affects clinical interventions in the delivery room.

Objective

To determine whether the availability of an EKG heart rate value and tracing to the clinical team has an effect on physiologic measures and related interventions during the stabilization of preterm infants.

Methods

Forty premature infants enrolled in a neuro-monitoring study who had an EKG monitor available were randomized to have the heart rate information from the bedside EKG monitor either displayed or not displayed to the clinical team. Heart rate, oxygen saturation, FiO2 and mean airway pressure from a data acquisition system were recorded every 2 seconds.

Comparison of EKG and Pulse Oximeter Heart Rate in the first 5 minutes. (Beats Per Minute).
Comparison of EKG and Pulse Oximeter Heart Rate in the first 5 minutes. (Beats Per Minute). © Anup Katheria Kathy Arnell Melissa Brown Kasim Hassen Mauricio Maldonado Wade Rich Neil Finer

Results were averaged over 30 seconds and the differences analyzed using two-tailed t-test. Interventions analyzed included time to first change in FiO2, first positive pressure ventilation, first increase in airway pressure, and first intubation.

Results

There were no significant differences in time to clinical interventions between the blinded and unblinded group, despite the unblinded group having access to a visible heart rate at 66 +/- 20 compared to 114 +/- 39 seconds for the blinded group. Pulse rate from oximeter was lower than EKG heart rate during the first 2 minutes of life, but this was not significant.

Conclusions

EKG provides an earlier and more accurate HR than pulse rate from an oximeter during stabilization of preterm infants at birth, allowing earlier intervention. HR may not actually drive interventions in the delivery room. Earlier EKG placement before pulse oximeter placement may affect other interventions, but this requires further research.

Source: A pilot randomized controlled trial of EKG for neonatal resuscitation