Neonatal Life Support

Octubre - 2020

 

 

III.- PHYSIOLOGICAL MONITORING AND FEEDBACK DEVICES


1.- Heart Rate Monitoring During Neonatal Resuscitation (NLS 898: EvUp)


After birth, the newborn’s heart rate is used to assess the effectiveness of spontaneous breathing and the need for interventions such as PPV, and it’s used as the marker of response to resuscitation interventions. Therefore, a rapid and reliable method of measuring the newborn’s heart rate is a critical adjunct for neonatal resuscitation.

The most recent review of this topic was included in the 2015 CoSTR for NLS.1,9,10 The NLS Task Force undertook an EvUp to identify additional evidence published after 2015 that would warrant consideration of a new SysRev.

 

Population, Intervention, Comparator, Outcome, Study Design, and Time Frame

  • Population: Newborns requiring resuscitation

  • Intervention: ECG monitoring

  • Comparator: Oximetry or auscultation

  • Outcome: Measurement of heart rate (speed and reliability) (important)21

The EvUp (Supplement Appendix C-3) identified 7 additional studies published after the 2015 CoSTR Sys- Rev,1,9,10 including 2 SysRevs,44,452 RCTs,46,47 and 3 observational studies.48–50 All 7 studies supported the 2015 treatment recommendation.1,9,10 Thus, the NLS Task Force agreed that no new ILCOR SysRev is warranted at  this time, and the current recommendation continues. Of note, there is a need to develop an additional interventional PICOST to determine if routine use of ECG monitoring during neonatal resuscitation improves clinical outcomes.

 

Also, improved tools and methods to enable detection and measurement of heart rate have been reported in the literature or are under development; as a result, the current PICOST question may be too limited in scope. Such methods include ew  heart rate monitors, digital stethoscopes, photoplethysmography methods in addition to pulse oximetry, and Doppler ultrasonography methods with auditory or  visual displays. New interfaces for ECG monitoring include dry electrode technology. Future SysRevs will need to compare these technologies to the current “gold standard” of ECG monitoring with gel electrodes. Until such evidence is available, the NLS Task Force agreed that there is no justification to seek a new SysRev or alter the current (2015) treatment recommendations.


Treatment Recommendation

  • This recommendation (below) has not changed from 2015.1,9,10

  • In babies requiring resuscitation, we suggest the ECG can be used to provide a rapid and accurate estimation of heart rate (weak recommendation, very  low certainty evidence).