Electronic Heart (ECG) Monitoring at Birth and Newborn Resuscitation

TL;DR

This study examines how using ECG monitoring during newborn resuscitation affects resuscitation methods and outcomes over time.

Contribution

The study evaluates the impact of implementing AHA-recommended ECG monitoring on resuscitation practices and outcomes.

Findings

Initial use of DR-ECG led to increased chest compressions at birth.

Educational interventions reduced the overuse of chest compressions.

Neonatal mortality remained unchanged after implementation.

Abstract

Background: Approximately 10% of newborns require assistance at delivery, and heart rate (HR) is the primary vital sign providers use to guide resuscitation methods. In 2016, the American Heart Association (AHA) suggested electrocardiogram in the delivery room (DR-ECG) to measure heart rate during resuscitation. This study aimed to compare the frequency of resuscitation methods used before and after implementation of the AHA recommendations. Methods: This longitudinal retrospective cohort study compared a pre-implementation (2015) cohort with two post-implementation cohorts (2017, 2021) at our Level IV neonatal intensive care unit. Results: An initial increase in chest compressions at birth associated with the introduction of DR-ECG monitoring was mitigated by focused educational interventions on effective ventilation. Implementation was accompanied by no changes in neonatal mortality. Conclusions: Investigation of neonatal outcomes during the ongoing incorporation of DR-ECG may help our understanding of human and system factors, identify ways to optimize resuscitation team performance, and assess the impact of targeted training initiatives on clinical outcomes.