Auscultate, palpate and tap: time to re-evaluate

Area of Science:

• Neonatal Medicine
• Clinical Assessment
• Medical Device Technology

Background:

• Accurate heart rate (HR) assessment is critical in neonatal resuscitation.
• Current methods rely on manual techniques like palpation, auscultation, and tapping.
• The accuracy and speed of these methods require evaluation.

Purpose of the Study:

• To evaluate the accuracy of current methods for assessing neonatal heart rate (HR).
• To compare the effectiveness of palpating a simulated umbilicus (UMB), tapping rate (TAP), and auscultating a simulated HR (AUSC).
• To determine the time taken for HR assessment using these methods.

Main Methods:

• Participants (n=29 healthcare staff) assessed simulated HRs of 54, 88, and 128 beats per minute (bpm).
• Methods included palpating a simulated umbilicus (UMB), listening to a tapping rate (TAP), and auscultating a simulated HR (AUSC).
• Accuracy was measured by correct range identification and time to assessment (<10 seconds).

Main Results:

• Assessment of 54 bpm (target range 0-59 bpm) was accurate in 17.2% (UMB), 17.2% (TAP), and 31% (AUSC).
• Assessment of 88 bpm (target range 60-100 bpm) was accurate in 82.8% (UMB), 79.3% (TAP), and 79.3% (AUSC).
• Assessment of 128 bpm (target >100 bpm) was accurate in 96.6% (UMB), 93.1% (TAP), and 93.1% (AUSC). Time to assessment varied across methods and rates.

Conclusions:

• Current manual methods for assessing HR below 60 bpm are inaccurate and may lead to overestimation.
• Reliance solely on these methods in neonatal resuscitation is not advised.
• Objective HR assessment tools should be readily available during all newborn resuscitations.