scholarly journals Heart Rate Assessment during Neonatal Resuscitation

Healthcare ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 43 ◽  
Author(s):  
Peter A. Johnson ◽  
Georg M. Schmölzer
Keyword(s):  
Heart Rate ◽  
Infant Mortality ◽  
Current Practice ◽  
Clinical Status ◽  
Newborn Infants ◽  
Neonatal Resuscitation ◽  
Novel Technologies ◽  
Hypoxic Injury ◽  
Neonatal Resuscitation Program ◽  
Neonatal Transition

Approximately 10% of newborn infants require some form of respiratory support to successfully complete the fetal-to-neonatal transition. Heart rate (HR) determination is essential at birth to assess a newborn’s wellbeing. Not only is it the most sensitive indicator to guide interventions during neonatal resuscitation, it is also valuable for assessing the infant’s clinical status. As such, HR assessment is a key step at birth and throughout resuscitation, according to recommendations by the Neonatal Resuscitation Program algorithm. It is essential that HR is accurate, reliable, and fast to ensure interventions are delivered without delay and not prolonged. Ineffective HR assessment significantly increases the risk of hypoxic injury and infant mortality. The aims of this review are to summarize current practice, recommended techniques, novel technologies, and considerations for HR assessment during neonatal resuscitation at birth.

Neonatal Resuscitation

2020 ◽  
pp. 64-66
Author(s):  
Anneka Hooft ◽  
Seema Shah
Keyword(s):  
United States ◽  
Emergency Department ◽  
Heart Rate ◽  
Neonatal Resuscitation ◽  
The United States ◽  
Pediatric Emergency ◽  
Positive Pressure ◽  
Respiratory Effort ◽  
Neonatal Resuscitation Program ◽  
Hospital Births

The majority of neonates born in the United States breathe spontaneously and do not require special assistance, but approximately 10% require some intervention, and less than 1% require extensive resuscitation measures. Although the number of infants delivered in the emergency department is unknown, out-of-hospital births have been increasing; thus, pediatric emergency physicians should be prepared for the possibility of a neonatal resuscitation in the emergency department. The acute resuscitation of the neonate should follow the Neonatal Resuscitation Program algorithm and includes assessment of heart rate, color, tone, and respiratory effort within the first minute of life. Initial treatment requires warming and gentle stimulation. Positive pressure ventilation should be initiated if the heart rate is <100 beats per minute, and chest compressions should be initiated if the heart rate is <60 beats per minute.

PP-100. The effect of the neonatal resuscitation program courses on the long-term neurodevelopmental outcome of newborn infants with perinatal asphyxia

2010 ◽  
Vol 86 ◽  
pp. S57-S58
Author(s):  
Ridvan Duran ◽  
Işık Görker ◽  
Yasemin Küçükuğurluoğlu ◽  
Nukhet Aladag Ciftdemir ◽  
Ulfet Vatansever Ozbek ◽  
...  
Keyword(s):  
Perinatal Asphyxia ◽  
Newborn Infants ◽  
Neurodevelopmental Outcome ◽  
Neonatal Resuscitation ◽  
Neonatal Resuscitation Program

Heart rate changes during positive pressure ventilation after asphyxia-induced bradycardia in a porcine model of neonatal resuscitation

2018 ◽  
Vol 104 (1) ◽  
pp. F98-F101 ◽  
Author(s):  
Maria Liza Espinoza ◽  
Po-Yin Cheung ◽  
Tze-Fun Lee ◽  
Megan O’Reilly ◽  
Georg M Schmölzer
Keyword(s):  
Heart Rate ◽  
Chest Compression ◽  
Positive Pressure Ventilation ◽  
Porcine Model ◽  
Neonatal Resuscitation ◽  
Positive Pressure ◽  
Term Newborn ◽  
Newborn Piglets ◽  
Severe Bradycardia ◽  
Neonatal Resuscitation Program

BackgroundThe Neonatal Resuscitation Program (NRP) states that if adequate positive pressure ventilation (PPV) was given for a low heart rate (HR), the infant’s HR should increase within the first 15 s of PPV.ObjectiveTo assess changes in HR in piglets with asphyxia-induced bradycardia.MethodsTerm newborn piglets (n=30) were anaesthetised, intubated, instrumented and exposed to 50 min normocapnic hypoxia followed by asphyxia. Asphyxia was achieved by clamping the tube until severe bradycardia (defined as HR at <25% of baseline). This was followed by 30 s adequate PPV and chest compression thereafter. Changes in HR during the 30 s of PPV were assessed and divided into four epochs (0–10 s, 5–15 s, 10–20 s and 20–30 s, respectively).ResultsIncrease in HR >100/min was observed in 6/30 (20%) after 30 s of PPV. Within the epochs 0–10 s, 5–15 s or 10–20 s no piglet had an increase in HR >100/min. Additional 10/30 (33%) had a >10% increase in HR.ConclusionIn contrast to NRP recommendation, adequate PPV does not increase HR within 15 s after ventilation in piglets with asphyxia-induced bradycardia.

scholarly journals Cardiac arrest with pulseless electrical activity rhythm in newborn infants: a case series

2019 ◽  
Vol 104 (6) ◽  
pp. F572-F574 ◽  
Author(s):  
Deandra Luong ◽  
Po-Yin Cheung ◽  
Keith J Barrington ◽  
Peter G Davis ◽  
Jennifer Unrau ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiopulmonary Resuscitation ◽  
Electrical Activity ◽  
Activity Rhythm ◽  
Healthcare Providers ◽  
Newborn Infants ◽  
Case Series ◽  
Neonatal Resuscitation ◽  
Pulseless Electrical Activity ◽  
Resuscitation Guidelines

The 2015 neonatal resuscitation guidelines added ECG to assess an infant’s heart rate when determining the need for resuscitation at birth. However, a recent case report raised concerns about this technique in the delivery room. We report four cases of pulseless electrical activity during neonatal cardiopulmonary resuscitation in levels II–III neonatal intensive care units in Canada (Edmonton [n=3] and Winnipeg [n=1]).Healthcare providers should be aware that pulseless electrical activity can occur in newborn infants during cardiopulmonary resuscitation. We propose an adapted neonatal resuscitation algorithm to include pulseless electrical activity. Furthermore, in compromised newborns, heart rate should be assessed using a combination of methods/techniques to ensure accurate heart rate assessment. When ECG displays a heart rate but the infant is unresponsive, pulseless electrical activity should be suspected and chest compression should be started.

Novel technologies for heart rate assessment during neonatal resuscitation at birth – A systematic review

Resuscitation ◽  
2019 ◽  
Vol 143 ◽  
pp. 196-207 ◽  
Author(s):  
Peter A. Johnson ◽  
Po-Yin Cheung ◽  
Tze-Fun Lee ◽  
Megan O’Reilly ◽  
Georg M. Schmölzer
Keyword(s):  
Systematic Review ◽  
Heart Rate ◽  
Neonatal Resuscitation ◽  
Novel Technologies

scholarly journals Assessment of heart rate changes during positive pressure ventilation in asphyxia induced bradycardia porcine model of neonatal resuscitation

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e59-e60
Author(s):  
Liza Espinoza ◽  
Po-Yin Cheung ◽  
Tze-Fun Lee ◽  
Megan O’Reilly ◽  
Georg Schmolzer
Keyword(s):  
Heart Rate ◽  
Animal Models ◽  
Endotracheal Tube ◽  
Positive Pressure Ventilation ◽  
Porcine Model ◽  
Neonatal Resuscitation ◽  
Positive Pressure ◽  
Newborn Piglets ◽  
The Mean ◽  
Neonatal Resuscitation Program

Abstract BACKGROUND The Neonatal Resuscitation Program (NRP) states that if positive pressure ventilation (PPV) was started because a baby had a low heart rate (HR), the baby’s HR should begin to increase within the first 15sec of PPV. However, this recommendation has not been examined in either an animal models nor in the delivery room. OBJECTIVES To assess changes in HR in piglets with asphyxia induced bradycardia. DESIGN/METHODS Term newborn piglets (n=30) were anesthetized, intubated, instrumented, and exposed to 40min normocapnic hypoxia followed by asphyxia. Asphyxia was achieved by clamping the endotracheal tube until the piglet had bradycardia (defined as HR 25% of baseline); at that time CPR was initiated. As per NRP protocol PPV was immediately started for 30sec followed by chest compression. HR was continuously recorded using an ECG during the whole duration of the experiment. Changes in HR during PPV were assessed and divided into four epochs (0-10sec, 5-15sec, 10-20sec and 20-30sec, respectively) after start of PPV. RESULTS The median (IQR) duration of asphyxia was similar between the groups with 189 (128–291)sec, 126 (70–197)sec, 118 (66–250)sec for 3:1C:V, SI+90 and SI+120 respectively (p=0.37; oneway ANOVA with Bonferroni). At time of start of PPV the mean (SD) HR was 35 (13)/min. An increase in HR >100/min was observed in 6/30 (5%) at 30 seconds of PPV. None achieved changes in HR at the epochs 0-10sec, 5-15sec, or 10-20sec. After 15sec of PPV 13/30 (43%) had a decrease in HR and 11/ 30 (36%) had no change in HR. CONCLUSION Adequate PPV does not increase HR in piglets with asphyxia induced bradycardia. This is contrary to the current NRP, which recommends that after 15 sec of PPV HR should be assessed.

Code Blue Events in the Neonatal and Pediatric Intensive Care Units at a Tertiary Care Children's Hospital

2020 ◽  
Author(s):  
Catherine M. Groden ◽  
Erwin T. Cabacungan ◽  
Ruby Gupta
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Life Support ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Neonatal Resuscitation ◽  
Advanced Life Support ◽  
Pediatric Intensive Care ◽  
Code Blue ◽  
Neonatal Resuscitation Program

Objective The authors aim to compare all code blue events, regardless of the need for chest compressions, in the neonatal intensive care unit (NICU) versus the pediatric intensive care unit (PICU). We hypothesize that code events in the two units differ, reflecting different disease processes. Study Design This is a retrospective analysis of 107 code events using the code narrator, which is an electronic medical record of real-time code documentation, from April 2018 to March 2019. Events were divided into two groups, NICU and PICU. Neonatal resuscitation program algorithm was used for NICU events and a pediatric advanced life-support algorithm was used for PICU events. Events and outcomes were compared using univariate analysis. The Mann–Whitney test and linear regressions were done to compare the total code duration, time from the start of code to airway insertion, and time from airway insertion to end of code event. Results In the PICU, there were almost four times more code blue events per month and more likely to involve patients with seizures and no chronic condition. NICU events more often involved ventilated patients and those under 2 months of age. The median code duration for NICU events was 2.5 times shorter than for PICU events (11.5 vs. 29 minutes), even when adjusted for patient characteristics. Survival to discharge was not different in the two groups. Conclusion Our study suggests that NICU code events as compared with PICU code events are more likely to be driven by airway problems, involve patients <2 months of age, and resolve quickly once airway is taken care of. This supports the use of a ventilation-focused neonatal resuscitation program for patients in the NICU. Key Points

scholarly journals Remote monitoring of patients with heart failure during the first national lockdown for COVID-19 in France

2021 ◽  
Author(s):  
Sylvain Ploux ◽  
Marc Strik ◽  
Saer Abu-Alrub ◽  
F Daniel Ramirez ◽  
Samuel Buliard ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Heart Rate ◽  
Remote Monitoring ◽  
Marked Decrease ◽  
Clinical Status ◽  
Health Care Use ◽  
Physiological Variables ◽  
Patients With Heart Failure ◽  
Vital Parameters

Abstract Background Multiparametric remote monitoring of patients with heart failure (HF) has the potential to mitigate the health risks of lockdowns for COVID-19. Aims To compare health care use, physiological variables, and HF decompensations during one month before and during the first month of the first French national lockdown for COVID-19 among patients undergoing remote monitoring. Methods Transmitted vital parameters and data from cardiac implantable electronic devices were analyzed in 51 patients. Medical contact was defined as the sum of visits and days of hospitalization. Results The lockdown was associated with a marked decrease in cardiology medical contact (118 days before vs 26 days during, -77%, p = 0.003) and overall medical contact (180 days before vs 79 days during, -58%, p = 0.005). Patient adherence with remote monitoring was 84±21% before and 87±19% during lockdown. The lockdown was not associated with significant changes in various parameters, including physical activity (2±1 to 2±1 h/day), weight (83±16 to 83±16 kg), systolic blood pressure (121±19 to 121±18 mmHg), heart rate (68±10 to 67±10 bpm), heart rate variability (89±44 to 78±46 ms, p = 0.05), atrial fibrillation burden (84±146 vs 86±146 h/month), or thoracic impedance (66±8 to 66±9 Ω). Seven cases of HF decompensations were observed before lockdown, all but one of which required hospitalization, versus six during lockdown, all but one of which were managed remotely. Conclusions The lockdown restrictions caused a marked decrease in health care use but no significant change in the clinical status of HF patients under multiparametric remote monitoring. lay summary The first French COVID-19 lockdown had a huge detrimental impact on conventional health care use (-78% in cardiology medical contact). However the lockdown had little impact over the short-term, if any, on vital parameters and the clinical status of patients with heart failure who were adherent to multiparametric remote monitoring. This remote monitoring strategy allowed early identification and home management of most of the heart failure decompensations during the lockdown.

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