Electrocardiogram for heart rate evaluation during preterm resuscitation at birth: a randomized trial

Area of Science:

• Neonatal Resuscitation
• Cardiology
• Pediatric Critical Care

Background:

• Electrocardiogram (ECG) offers faster heart rate (HR) detection than pulse oximetry.
• The impact of routine ECG use during delivery room (DR) resuscitation on preterm infants remains unclear.

Purpose of the Study:

• To determine if routine ECG use in the DR reduces time to stabilization for preterm infants (<31 weeks' gestation).

Main Methods:

• Randomized controlled trial comparing ECG-displayed versus ECG-blinded HR assessment in neonates <31 weeks' gestation.
• Monitored HR, oxygen saturation, resuscitation interventions (e.g., positive pressure ventilation), and clinical outcomes.

Main Results:

• No significant difference in time to stabilization (HR ≥100 bpm and target oxygen saturation) between groups [360 (269, 435) vs 345 (240, 475) s].
• No difference in time to achieve HR ≥100 bpm or duration of positive pressure ventilation.
• Clinical outcomes were similar across both groups.

Conclusions:

• Routine ECG use in the DR for preterm resuscitation is feasible and safe but does not reduce time to stabilization.
• This finding contributes to limited RCT evidence on routine ECG use in DR resuscitation, important for global guideline considerations.