Pedi-cap color change precedes a significant increase in heart rate during neonatal resuscitation

Introduction: Heart rate is the most important indicator of infant well-being during neonatal resuscitation. The Nellcor Pedi-Cap turns gold when exposed to exhaled gas with CO2 > 15 mmHg. The aim of this study was to determine if Pedi-Cap gold color change during neonatal resuscitation precedes an increase in heart rate in babies with bradycardia receiving mask ventilation. Methods: This was a single-center retrospective review of video recordings and physiologic data of newborns with bradycardia receiving mask positive pressure ventilation during neonatal resuscitation. Subjects were included if the baby's HR < 100 BPM within the first 90 s of resuscitation. The primary outcome was the change in HR prior to Pedi-Cap gold color change compared to the HR after Pedi-Cap gold color change. Results: Forty-one newborns during the study period had HR < 100 BPM and received mask positive pressure ventilation with a Pedi-Cap. The median heart rate 10 s prior to Pedi-Cap gold color change was 75 BPM (IQR 62-85) and increased to 136 BPM (IQR 113-158) 30 s after gold color change (p < 0.001). SpO(2) increased from 45 +/- 17% prior to Pedi-Cap gold color change to 52 +/- 17% 30 s after gold color change (p = 0.001). Conclusions: Colorimetric CO2 detection during mask positive pressure ventilation in neonatal resuscitation precedes a significant increase in heart rate and SpO(2). The Pedi-Cap can be easily applied during resuscitation, requires no electricity, provides immediate feedback and may be a useful, simple tool early in resuscitation and may be especially useful in resource limited settings. (C) 2014 Elsevier Ireland Ltd. All rights reserved.