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The relation between given volume and heart rate during newborn resuscitation
J E Linde1, J Schulz2, J M Perlman3
1Department of Pediatrics, Stavanger University Hospital, Norway.
Resuscitation
|June 14, 2017
Summary
Positive pressure ventilation (PPV) in newborns is linked to heart rate (HR) increases. A tidal volume (TV) of 9.3ml/kg during PPV optimized HR response, with pauses for stimulation also boosting HR.
Area of Science:
- Neonatal resuscitation
- Pediatric cardiology
- Physiology
Background:
- Establishing functional residual capacity (FRC) and appropriate tidal volume (TV) are critical for circulatory recovery in depressed newborns during delivery room resuscitation.
- Effective positive pressure ventilation (PPV) is known to increase heart rate (HR), but the precise relationship between TV delivery and HR response is not well understood.
Purpose of the Study:
- To investigate the relationship between delivered TV during initial PPV and the HR response in depressed newborns.
- To identify the optimal delivered TV that is associated with the most rapid increase in HR.
Main Methods:
- Ventilation and ECG signals were recorded during neonatal resuscitation in a Tanzanian rural hospital using Neonatal Resuscitation Monitors.
- Positive pressure ventilation (PPV) was administered without positive end-expiratory pressure or supplemental oxygen.
- Perinatal events were documented by research assistants.
Main Results:
- A non-linear relationship was observed between delivered TV and the increase in HR.
- A TV of 9.3ml/kg was associated with the largest HR increase during PPV.
- Intermittent pauses in PPV for stimulation/suctioning led to further HR increases, particularly in newborns with an initial HR below 100 beats/minute.
Conclusions:
- A consistent positive correlation exists between the increase in HR and the delivered TV during PPV.
- The observed HR increases during PPV pauses suggest that many newborns may experience primary apnea, responding well to stimulation.
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