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Updated: Feb 19, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
A pilot randomized controlled trial of EKG for neonatal resuscitation
Anup Katheria1, Kathy Arnell1, Melissa Brown1
1Neonatal Research Institute, Sharp Mary Birch Hospital, San Diego, CA, United States of America.
Insights
Electrocardiogram (EKG) provides earlier and more accurate heart rate monitoring for preterm infants during stabilization. While not statistically significant in this small trial, visible EKG data allowed for earlier interventions in the delivery room.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Clinical Monitoring
Background:
- The American Academy of Pediatrics recommends cardiac monitoring for infants requiring resuscitation.
- Previous studies indicate electrocardiogram (EKG) heart rate is available sooner than pulse oximeter data.
- The impact of real-time EKG availability on delivery room interventions remains unstudied.
Purpose of the Study:
- To evaluate the effect of visible electrocardiogram (EKG) heart rate data on physiological measures and interventions during preterm infant stabilization.
- To determine if immediate EKG access influences clinical decision-making in the delivery room.
Main Methods:
- Forty preterm infants in The Neu-Prem Trial were randomized to have EKG heart rate data displayed or not.
- Continuous monitoring of heart rate, oxygen saturation, FiO2, and mean airway pressure was performed.
- Interventions such as changes in FiO2, positive pressure ventilation, and intubation were analyzed.
Main Results:
- The group with visible EKG data had heart rate information available significantly earlier (66 vs. 114 seconds).
- No significant differences were observed in the timing of clinical interventions between the groups.
- Pulse oximeter heart rate was lower than EKG heart rate in the initial two minutes, though not significantly.
Conclusions:
- Electrocardiogram (EKG) offers earlier and more precise heart rate assessment than pulse oximetry in stabilizing preterm infants.
- While earlier interventions were noted in the visible EKG group, this small trial lacked statistical significance.
- Further research is needed to explore the impact of earlier EKG monitoring on subsequent clinical interventions.
Background:
The seventh edition of the American Academy of Pediatrics Neonatal Resuscitation Program recommends the use of a cardiac monitor in infants that need resuscitation. 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.
Design/Methods:
Forty (40) premature infants enrolled in a neuro-monitoring study (The Neu-Prem Trial: NCT02605733) 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. 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 (p < .0001). Pulse rate from oximeter was lower than EKG heart rate during the first 2 minutes of life, but this was not significant.
Conclusion(S):
EKG provides an earlier, and more accurate heart rate than pulse rate from an oximeter during stabilization of preterm infants, allowing earlier intervention. All interventions were started earlier in the unblinded EKG group but these numbers were not significant in this small trial. Earlier EKG placement before pulse oximeter placement may affect other interventions, but this needs further study.
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