• Rashmi Gulati, Lameace Sayegh, Cathy McCurley, Fabien Eyal, and Michael Zayek.
• University of South Alabama Children's and Women's Hospital, 1700 Center Street, Mobile, AL 36604, USA. Electronic address: Rashmi.gulati@gmail.com.
• Resuscitation. 2023 Nov 1; 192: 109961109961.

BackgroundThe recent Neonatal Resuscitation Program advises the early utilization of an electrocardiogram (ECG) for non-vigorous newborns in the delivery room. However, placing ECG electrodes on the chest may delay obtaining a reliable heart rate (HR) and could interfere with chest compressions. Our previous study showed that preset ECG electrodes, attached to the back of the newborn, are quicker than a pulse oximeter (POX) for detecting HR.AimTo compare time to detect a reliable HR using back-placed ECG electrodes versus standard front placement.MethodsInfants were randomly assigned to back (n = 85) or chest (n = 89) electrode placement. Time measurement began upon placing infants on a Panda warmer ResusView. Failure was defined as no HR detected within 5 minutes. Intention-to-treat analysis compared HR signal acquisition time between groups.ResultsBoth groups showed similar proportions of detectable HR within the first minute. Median (IQR) time to obtain HR was 26 (13,38) seconds for the chest group and 21 (12,54) seconds for the back group (p = 0.91). A large number of vigorous infants were included. In the chest group, these vigorous infants had shorter HR acquisition times than non-vigorous infants (Mean ± SD of 34 ± 48 seconds vs. 50 ± 44 seconds respectively; p = 0.049). Failure rates and time to acquire a HR for infants who were non-vigorous and required advanced resuscitation were similar between the back and chest groups (p = 0.51).ConclusionPreset back ECG electrodes have shown encouraging results in neonates requiring advanced resuscitation. Further studies are needed to enhance guidance during neonatal resuscitation.Copyright © 2023 Elsevier B.V. All rights reserved.

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