Impact of Postnatal Heart Rate Assessment on Delayed Cord Clamping in Neonatal Resuscitation

This study aimed to determine whether immediate postnatal heart rate (HR) assessment during delayed cord clamping (DCC) influences the clinical decision-making of neonatal resuscitation providers.

The decision to perform or defer DCC primarily relies on subjective parameters, potentially leading to variations in subsequent steps of the resuscitation algorithm. In this study, HR, a numerical parameter, was introduced during DCC. Ten subjects completed a total of 60 short scenarios simulating DCC for a 27-week preterm manikin. Each subject experienced two consecutive sets (control vs. test) of three scenarios with predefined HR ranges (<60, 60-99, and ≥ 100/minute) presented in random order. In control scenarios, subjects participated in the DCC procedure per usual practice. In test scenarios, they manually measured HR during DCC. Objective variables and subjective questionnaire responses were collected.

The mean DCC duration significantly increased for HR 60 to 99/minute (45.4 vs. 55.3 seconds, p = 0.035) and HR ≥ 100/minute (37.1 vs. 63.7 seconds, p = 0.011) scenarios in the test group compared with the control. For the HR < 60/minute scenario, mean DCC duration and time to ECG attachment tended to be shorter in the test group (45.4 vs. 34.6 and 89.7 vs. 56.3 seconds, respectively). In this HR range, initiation of respiratory support occurred significantly earlier in the test group (mean 72.7 vs. 47.6 seconds, p = 0.020). According to the questionnaire, 2 (20%) subjects believed tone and respiratory effort were sufficient for DCC decision-making. Seven (70%) subjects perceived that HR assessment during DCC had a "strong" or "very strong" impact on the decision to delay or proceed with cord clamping, with confidence levels rising from a median of 3 to 4 on a 5-point Likert scale.

Assessing immediate postnatal HR during DCC appears to impact clinical decision-making for providers, implying the potential for enhancing uniformity of decisions among healthcare professionals surrounding DCC.

· The decision to perform or defer DCC primarily relies on subjective parameters.. · HR assessment during DCC appears to impact clinical decision-making for providers.. · Assessing HR during DCC may potentially enhance uniformity of decisions among HCPs..