Ann Pediatr Res | Volume 4, Issue 4 | Research Article | Open Access
Mary Grace S Tan1,5*, Li Wen Lee2, Imelda Ereno1,4,5, Vina Tagamolila1,5, Priyantha Edison1,4,5, Hao Ying3, Selina Ho1,2,4,5 and Cheo Lian Yeo1,2,4,5
1Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore 2Duke-NUS Medical School, Singapore 3Health Services Research Centre, SingHealth Services, Singapore 4Yong Loo Lin School of Medicine, National University of Singapore, Singapore 5Lee Kong Chian, School of Medicine, Singapore
*Correspondance to: Mary Grace S Tan
Fulltext PDFIntroduction: Heart rate (HR) determination is vital in a neonatal resuscitation. Evidence suggests that electrocardiogram (ECG) provides more rapid and accurate measurement of Heart Rate (HR). Recent neonatal resuscitation guidelines recommended the use of the ECG over conventional methods such as auscultation using a stethoscope, palpation of umbilical cord pulsations by placing the cord between the thumb and index finger or the brachial or femoral artery, and pulse rate (PR) measurement using the pulse oximeter (POX). However, concerns regarding clinical feasibility of applying ECG electrodes and the potential risk of damage to newborn’s skin have been raised as barriers to its implementation. Objectives: The study aims to assess the feasibility of using ECG to determine the HR as compared to PR measured using the POX by comparing (1) time taken to apply ECG leads vs. POX sensors (seconds), (2) time taken to display of first reliable HR/PR (seconds) and evaluating the agreement between HR measured on ECG versus PR measured using the POX. Methods: Eligible deliveries managed in the Department of Obstetrics and Gynecology at Singapore General Hospital from October 2018 to May 2019 was enrolled. Newly born infants had both ECG/ POX sensors applied from the time the neonate was placed under the resuscitaire with continuous HR and PR monitoring initiated simultaneously. Time to apply ECG electrodes and POX sensors and time to display of reliable HR and PR tracings were compiled and compared using the Wilcoxon signed rank test. Results: Of the 104 infants enrolled and analyzed, the median (interquartile range, IQR) time to obtain a reliable HR on ECG was 10 (5.0 to 20.0) vs. 30.5 (22.8 to 53.0) sec on the POX (p<0.001). The median 1st reliable HR reading on ECG is higher at 170 beats per minute (bpm) as compared to 167 bpm on POX (p=0.002). In addition, the time taken to apply ECG leads is faster compared to the POX sensors. Looking at the median time, it takes 27 sec for the ECG leads to be applied as compared to the POX sensors that requires 33.5 sec with p-value <0.001. Conclusion: The ECG provided a faster and more reliable display of HR reading during resuscitation than PR on POX.
Electrocardiogram(ECG); Heart Rate(HR); Pulse Oximeter(POX); Pulse Rate(PR); Neonatal Resuscitation
Tan MGS, Wen L, Ereno I, Tagamolila V, Edison P, Ying H, et al. Heart Rate Determination Using Electrocardiogram in Comparison with Pulse Oximeter at Neonatal Resuscitation: The Singapore General Hospital Experience. Ann Pediatr Res. 2020; 4(4): 1047..