Elsevier

Resuscitation

Volume 71, Issue 3, December 2006, Pages 319-321
Resuscitation

Clinical paper
Accuracy of clinical assessment of infant heart rate in the delivery room

https://doi.org/10.1016/j.resuscitation.2006.04.015Get rights and content

Summary

Heart rate (HR) dictates intervention during neonatal resuscitation. Guidelines recommend that HR be assessed by auscultation or palpation. We compared HRs determined clinically with electrocardiography (ECG) in healthy newborns in the delivery room. Clinical assessment by 23 observers randomly allocated to assess HR by one of two methods in 26 infants, was found to be inaccurate and underestimate ECG HR. The mean difference between HR assessed by auscultation and palpation ECG and HR using methodology recommended by the Neonatal Resuscitation Programme was 14 and 22 beats per minute respectively.

Introduction

International consensus statements recommend that the need for, and response to resuscitation in newborn infants be determined clinically, with the heart rate being the most important sign.1, 2 Counting the heart rate (HR) by auscultation of the praecordium with a stethoscope or palpation of umbilical cord pulsations are the recommended techniques.1, 3 Auscultation of the HR has been shown to be inaccurate in a model,4 while palpation has been shown to be inferior to auscultation in newborns in the delivery room.5 Neither method has been compared to electrocardiography (ECG) in the delivery room. We wished to determine the accuracy of clinical assessment of HR by comparing it to ECG in the delivery room (DR).

Section snippets

Methods

Approval for this study was obtained from the Human Research and Ethics Committees of the Royal Women's Hospital. We identified impending low-risk term births and approached parents for consent prior to delivery. Vigorous infants who were not resuscitated were enrolled. The chest and right thigh were cleaned using Skin-Prep® wipes (Smith & Nephew, FL USA) and three ECG leads (Kittycat, Tyco Healthcare, Mansfield, MA, USA) applied. With the infant on the Resuscitaire, two leads were applied to

Results

Twenty-three observers (2 consultant neonatologists, 3 neonatal fellows, 7 pediatric registrars, 11 neonatal nurses) assessed 26 infants (mean (S.D.) gestational age and birth weight 38 (2) weeks and 3191 (681) g, respectively). All infants were active and no infant received respiratory support.

Comparison of clinical assessment of HR by auscultation with ECG recordings were performed in all infants. However, cord pulsations were impalpable at the time of assessment in 5 (19%) infants. The mean

Discussion

Immediately after birth the new born infant's HR guides the need for resuscitation.1, 2 The best way to monitor HR at this time has not been determined. This study compared different ways of counting HR in the delivery room in newly born infants who did not require resuscitation. Vigorous new born infants were studied because this was the nearest we could get to investigating the clinical assessment of HR accurately immediately after birth. Although it would have been optimal to study HR in

Conflict of interest statement

None.

Acknowledgements

COFK and CPFO’D both are in receipt of the Royal Women's Hospital Postgraduate Degree Scholarship. PGD is supported by a National Health and Medical Research Council Fellowship.

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A Spanish translated version of the summary of this article appears as Appendix in the online version at doi:10.1016/j.resuscitation.2006.04.015.

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