Tactile stimulation and newborn heart rate responses in the delivery room: an observational video study

Newborn resuscitation guidelines recommend stimulation as a first step in non-breathing newborns to facilitate spontaneous breathing. We aimed to evaluate the extent of stimulation in the delivery room, heart rate (HR) responses to stimulation, and association between bradycardia (HR <100 beats per minute (bpm) ≥10 s) in the first minute after birth and the need for positive pressure ventilation (PPV) versus stimulation alone.

A prospective observational study conducted at tertiary level Stavanger University Hospital, Norway, September 2022-July 2024 including newborns with gestational age ≥34 weeks. Stimulation was registered from thermal videos in the delivery room and visible light cameras over resuscitaires. HR was obtained using dry-electrode ECG.

449 included newborns had thermal videos ± visible light video and HR data. 70/449 (16%) newborns did not receive any resuscitative interventions, 345/449 (77%) received stimulation alone, 14/449 (3.1%) received continuous positive airway pressure, and 20/449 (4.4%) received PPV. We observed a HR increase of median 7 bpm among newborns with HR <140 bpm at start stimulation (p < 0.001). Newborns with bradycardia in the first minute after birth had four-fold likelihood of requiring PPV versus tactile stimulation alone (OR 4.81 95% CI 1.39-15.3, p = 0.009).

Tactile stimulation is widely applied during neonatal transition. We observed an increase in HR in relation to tactile stimulation, especially among newborns with HR <140 bpm at start stimulation. Newborns with bradycardia (HR <100 bpm ≥10 s) in the first minute after birth had a four-fold likelihood of requiring PPV versus tactile stimulation alone.