Pulse oximetry versus electrocardiogram for heart rate assessment during resuscitation of the preterm infant

Background: Heart rate (HR) assessment is essential during neonatal resuscitation, and it is usually done by auscultation or pulse oximetry (PO). The aim of the present study was to determine whether HR assessment with ECG is as fast and reliable as PO during preterm resuscitation. Material and methods: Thirty-nine preterm (<32 weeks of gestational age and/or <1.500 g of birth weight) newborn resuscitations were video-recorded. Simultaneous determinations of HR using ECG and PO were registered every 5 s for the first 10 min after birth. Time needed to place both devices and to obtain reliable readings, as well as total time of signal loss was registered. The proportion of reliable HR readings available at the beginning of different resuscitation manoeuvres was also determined. Results: Time needed to connect the ECG was shorter compared with the PO (26.64 +/- 3.01 vs. 17.10 +/- 1.28 s, for PO and ECG, respectively, P<.05). Similarly, time to obtain reliable readings was shorter for the ECG (87.28 +/- 12.11 vs. 26.38 +/- 3.41 s, for PO and ECG, respectively, P<.05). Availability of reliable HR readings at initiation of different resuscitation manoeuvres was lower with the PO (PO vs. ECG for positive pressure ventilation: 10.52 vs. 57.89% P<.05; intubation: 33.33 vs. 91.66%, P<.05). PO displayed tower HR values during the first 6 min after birth (P<.05, between 150 and 300 s). Conclusions: Reliable HR is obtained later with the PO than with the ECG during preterm resuscitation. PO underestimates HR in the first minutes of resuscitation. (C) 2015 Asociacion Espanola de Pediatria. Published by Elsevier Espana, S.L.U. All rights reserved.