Gentle limb fixation for a faster reliable heart rate obtained with pulse oximeter at birth.

Abstract

Pulse oximetry is widely used to monitor heart rate (HR) and peripheral oxygen saturation during neonatal resuscitation. As HR is a key parameter guiding clinical decision-making during initial assessment and stabilization, timely and accurate HR readings are critical. However, it can take minutes to achieve a reliable reading directly after birth. This study aimed to determine whether infant limb movement and gentle fixation after pulse-oximeter application influence the time to obtain the first reliable HR. Video recordings of neonatal resuscitations with simultaneous pulse oximetry readings were retrospectively analyzed for neonates ≥24 weeks' gestation. Neonates were categorized into three groups based on the status of the right limb during the first 10 s after sensor application: (1) movement, (2) no movement, or (3) gentle fixation by a caregiver. Time to the first reliable HR_PO was determined using a custom-developed, ECG-validated algorithm applied to the photoplethysmogram. A total of 178 neonates were included, with a median gestational age of 30 + 4 weeks (28 + 4-33 + 6), with no significant differences between groups. Median time to achieve a reliable HR_PO was significantly shorter in the "no movement" (20.3 [16.1-34.2] s) and "fixation" (17.9 [14.9-25.4] s) groups as compared to the "movement" group (46.2 [23.5-75.1] s) (p < 0.001). The percentage of neonates who achieved a reliable HR_PO within 30 s after application was significantly higher after limb fixation (80.5%) versus no fixation (49.6%) (p < 0.001). Pulse oximetry does not seem motion artefact resistant when the first HR is obtained. Gentle limb fixation after sensor application may facilitate more timely clinical assessment.