Abstract

A device for newborn heart rate (HR) monitoring at birth that is compatible with delayed cord clamping and minimises hypothermia risk could have advantages over current approaches. We evaluated a wireless, cap mounted device (fhPPG) for monitoring neonatal HR. A total of 52 infants on the neonatal intensive care unit (NICU) and immediately following birth by elective caesarean section (ECS) were recruited. HR was monitored by electrocardiogram (ECG), pulse oximetry (PO) and the fhPPG device. Success rate, accuracy and time to output HR were compared with ECG as the gold standard. Standardised simulated data assessed the fhPPG algorithm accuracy. Compared to ECG HR, the median bias (and 95% limits of agreement) for the NICU was fhPPG -0.6 (-5.6, 4.9) vs PO -0.3 (-6.3, 6.2) bpm, and ECS phase fhPPG -0.5 (-8.7, 7.7) vs PO -0.1 (-7.6, 7.1) bpm. In both settings, fhPPG and PO correlated with paired ECG HRs (both R2 =0.89). The fhPPG HR algorithm during simulations demonstrated a near-linear correlation (n=1266, R2 =0.99). Monitoring infants in the NICU and following ECS using a wireless, cap mounted device provides accurate HR measurements. This alternative approach could confer advantages compared with current methods of HR assessment and warrants further evaluation at birth.

Highlights

  • 10% of newborns require assistance at birth to establish breathing with 3% needing more sustained stabilisation or resuscitation.[1]

  • Pulse oximetry (PO) is widely used on neonatal intensive care units (NICUs), but uptake in the delivery room is not universal 7 potentially because of the delay of a few minutes to obtain a reliable heart rate (HR) after birth due to poor peripheral perfusion and motion.[8]

  • We have previously described a prototype wired, forehead-mounted sensor studied in NICU patients that utilises reflectance-mode green light photoplethysmography (PPG) to measure HR.[13]

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Summary

Introduction

10% of newborns require assistance at birth to establish breathing with 3% needing more sustained stabilisation or resuscitation.[1]. This could explain why PO underestimates HR when compared to ECG during the first minutes of life.[9,10]

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