Optimal site of tactile stimulation during initial steps of neonatal resuscitation: a three-arm randomized controlled trial.

Abstract

The optimum site of tactile stimulation (TS) during initial steps of neonatal resuscitation in the delivery room (DR) is not well-established. To compare the impact of three different sites of TS (back rub, trunk rub, and sole rub) on peripheral oxygen saturation (SpO₂) at 5 min of life in non-crying infants at birth. In this three-arm, parallel-group, randomized controlled trial, 183 neonates ≥32 weeks' gestation were allocated to receive 3-5 sole rubs (n = 60), trunk rubs (n = 60), and back rubs (n = 63) during initial steps of resuscitation. The primary outcome was SpO₂ (%) at 5 min. Secondary outcomes were time to first-cry/grimace, duration of initial steps, minute-specific SpO₂, heart rate (HR) and FiO₂ trends till 10 min, need for further resuscitation in DR, regional cerebral oxygenation (CrSO₂) at one hour, and in-hospital adverse events, including mortality. Stata 18 was used for an intention-to-treat analysis. There was no difference in 5-min SpO₂ (%) across the groups (83.1 ± 11.7, 85.4 ± 11.9, and 82.4 ± 14.8, in sole rub, trunk rub and back rub groups, respectively; p = 0.392). The minute-specific changes in HR, and SpO₂ were comparable across the groups. FiO₂ requirement was higher (2-10 min) in the back rub group, though the difference did not reach statistical significance. Other outcomes including CrSO₂ and in-hospital complications were similar. There was no procedure-related complication in any group. There was no difference in 5-min SpO₂, need for further resuscitation in DR, cerebral oxygenation, and in-hospital complications with the three modes of TS, sole rub, trunk rub and back rub.