Abstract
Background
6.5–9 million newborns worldwide require resuscitation at birth annually. During neonatal
resuscitation, inaccurate or slow heart rate (HR) assessments may significantly increase
risk of infant mortality or morbidity. Therefore fast, accurate, and effective HR
assessment tools are critical for neonatal resuscitation.
Objective
To systematically review the literature about accuracy, latency, and efficacy of technologies
for HR assessment during neonatal resuscitation.
Methods
Adhering to PRISMA guidelines, PubMed, EMBASE, and Google Scholar databases were systematically
searched to identify studies related to technologies for HR assessment, which could
be used to guide neonatal resuscitation.
Results
Forty-six studies evaluating HR assessment technologies for neonatal resuscitation
were identified. In total, 16 studies (3/16 randomized trials and 13/16 observational
studies) compared two or more HR assessment technologies to measure accuracy, latency,
and efficacy. Of the trials, 1/3 had a low risk of bias while 2/3 had high risks.
All observational studies had high risks of bias. Most studies considered infants
not requiring resuscitation, constituting indirect evidence and lower certainty in
the context of neonatal resuscitation. Two trials reported faster times to HR assessment
using electrocardiogram with a mean(SD) 66(20) versus 114(39) s and a median(IQR)
24(19–39) versus 48(36–69) s (both p < 0.001), compared to pulse oximetry.
Conclusion
While electrocardiography is faster to assess HR at birth and more reliable to detect
HR changes compared to other recommended technologies, practice should not exclusively
rely on ECG. While novel technologies could support HR assessment, no studies validate
their clinical efficacy during neonatal resuscitation.
Abbreviations:
NRP (Neonatal Resuscitation Program), HR (heart rate), PO (pulse oximetry), ECG (electrocardiography), PEA (pulseless electric activity), bpm (beats per minute), CI (confidence interval), SD (standard deviation), IQR (interquartile range), DS (digital stethoscope), PPG (photoplethsymography), PZT (piezoelectric transducer)Keywords
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Article info
Publication history
Published online: July 19, 2019
Accepted:
July 9,
2019
Received in revised form:
June 25,
2019
Received:
February 4,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
