# Impact of electrocardiogram monitoring on the frequency of tracheal intubation at birth

## TL;DR

This study found that using an electrocardiogram monitor during newborn resuscitation did not reduce tracheal intubation rates and was linked to delayed positive pressure ventilation.

## Contribution

The study provides new evidence that ECG monitoring during neonatal resuscitation does not decrease intubation frequency and may delay ventilation initiation.

## Key findings

- ECG monitoring did not reduce tracheal intubation frequency in either preterm or term infants.
- ECG monitoring was associated with a 2.45-fold increase in odds of delayed PPV initiation in term infants.
- ECG monitoring was associated with a 2.72-fold increase in odds of delayed PPV initiation in preterm infants.

## Abstract

To determine whether the use of an electrocardiogram monitor in newborns receiving positive pressure ventilation (PPV) at birth affects the frequency of tracheal intubation in the delivery room.

Retrospective cohort of liveborn infants without congenital anomalies, with gestational age (GA) ≥ 23 weeks and birth weight ≥ 400 g who received PPV at birth, from 2014 to 2022. Newborns were stratified by GA (< 34 or ≥ 34 weeks) and by use or non-use of an electrocardiogram monitor during resuscitation. Logistic regression was used to assess the association between electrocardiogram monitoring and outcomes of interest for each GA group.

Among 5622 live births, 516 met the inclusion criteria; 224 (43 %) were monitored, and 292 (57 %) were not. The frequency of tracheal intubation was similar between monitored and non-monitored groups: ≥ 34 weeks - 13 % vs. 14 %; < 34 weeks - 43 % vs. 43 %. Electrocardiogram monitoring increased the odds of initiating PPV with a face mask ≥ 60 seconds after birth by 2.45-fold (95 % CI: 1.08–5.54) for GA ≥ 34 weeks and by 2.72-fold (95 % CI: 1.13–6.59) for GA < 34 weeks, after adjustment for umbilical cord clamping time, year of birth, and birth weight.

Electrocardiogram monitor use did not reduce the frequency of tracheal intubation and was associated with delayed initiation of PPV with a face mask.