• Resuscitation · Oct 2019

    Observational Study

    Impact of electronic cardiac (ECG) monitoring on delivery room resuscitation and neonatal outcomes.

    • Birju A Shah, Anne G Wlodaver, Marilyn B Escobedo, Syed T Ahmed, Michelle H Blunt, Michael P Anderson, and Edgardo G Szyld.
    • Neonatal-Perinatal Medicine, The Children's Hospital, OU Medicine, Oklahoma City, OK, USA; Pediatrics, College of Medicine, University of Oklahoma, Oklahoma City, OK, USA. Electronic address: Birju-Shah@ouhsc.edu.
    • Resuscitation. 2019 Oct 1; 143: 10-16.

    AimIn 2016, the neonatal resuscitation guidelines suggested electronic cardiac (ECG) monitoring to assess heart rate for an infant receiving positive pressure ventilation immediately after birth. Our aim was to study the impact of ECG monitoring on delivery room resuscitation interventions and neonatal outcomes.MethodsObservational cohort study compared maternal, perinatal and infant characteristics, before (retrospective cohort, calendar year 2015) and after (prospective cohort, calendar year 2017) implementation of ECG monitoring in the delivery room. Association of ECG monitoring with delivery room resuscitation practice interventions and neonatal outcomes was assessed using unadjusted and adjusted multivariable regression analyses.ResultsOf 632 newly born infants who received positive pressure ventilation in the delivery room, ECG monitoring was performed in 369 (the prospective cohort) compared with no ECG monitoring in 263 (the retrospective cohort). Compared to neonates in the retrospective cohort, neonates with ECG monitoring had a significantly lower endotracheal intubation rate (36% vs 48%, P < .005) in the delivery room and higher 5-min Apgar scores (7 [5-8] vs 6 [5-8], P < .05). There was no difference in mortality (31 [8%] vs 23 [9%]), but infants who received ECG monitoring had increased odds of receiving chest compressions with an adjusted odds ratio of 3.6 (95% confidence interval: 1.4-9.5).ConclusionIntroduction of ECG monitoring in the delivery room was associated with fewer endotracheal intubations, and an increase use of chest compressions with no difference in mortality.Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.

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