Smartphone app for neonatal heart rate assessment: an observational study

Area of Science:

• Neonatal resuscitation
• Medical technology
• Global health

Background:

• Accurate heart rate (HR) assessment is vital for neonatal resuscitation.
• Standard methods like pulse oximetry (PO) and electrocardiography (ECG) are often inaccessible in low-resource settings.
• A novel, free smartphone application, NeoTap, utilizes a screen-tapping method for HR recording.

Purpose of the Study:

• To evaluate the accuracy and speed of the NeoTap smartphone application for neonatal heart rate assessment.
• To compare NeoTap's performance against established methods (PO and ECG) in diverse clinical scenarios.

Main Methods:

• An observational study conducted in Uganda (May 2015 - January 2019) involved three phases.
• Phase 1: Low-resource users (midwives) recorded metronome rates using NeoTap (n=180).
• Phase 2: High-resource users (pediatricians) recorded HR in breathing neonates using NeoTap vs. PO (n=69).
• Phase 3: Low-resource users recorded HR in non-breathing neonates using NeoTap vs. ECG (n=235).

Main Results:

• High-resource users: NeoTap showed a mean difference of 3 bpm vs. PO (5-second acquisition).
• Low-resource users: NeoTap showed a mean difference of 6 bpm vs. metronome (2.7-second acquisition) and 3 bpm vs. ECG in non-breathing neonates.
• Agreement between NeoTap and ECG was good for HR ≥60 bpm (kappa=0.71), with limitations at HR <60 bpm.

Conclusions:

• NeoTap enables accurate and rapid heart rate assessment in neonates, particularly in low-resource environments.
• While less precise with wider confidence intervals for less experienced users, NeoTap provides valuable clinical data, especially in non-breathing neonates.
• Further research and training, potentially focusing on auscultation, are recommended for optimal clinical integration of NeoTap.