Clinical paperAccuracy of clinical assessment of infant heart rate in the delivery room☆
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).
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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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Cited by (0)
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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.