What is the clinical evidence from this study?

Study design: Observational. Population: healthy newborns ≥35+0 weeks’ gestation after caesarean delivery (n=89). Intervention: Extrauterine placental transfusion and physiology-based cord clamping. Primary outcome: Heart rate (HR) recorded every second for 10 min.

What does this research mean for the field?

Extrauterine placental transfusion and physiology-based cord clamping in healthy newborns after caesarean delivery results in a median heart rate peaking at 169 bpm at 4 minutes, which is not significantly affected by intact-cord blood sampling, placental delivery, or cord clamping. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To describe the normal heart rate of healthy newborns ≥35+0 weeks’ gestation post-caesarean delivery with extrauterine placental transfusion.

April 22, 2026Open Access

Heart rate trends in healthy newborns ≥35+0 weeks’ gestation after caesarean delivery with extrauterine placental transfusion and physiology-based cord clamping: a Norwegian observational study (INTACT-3)

Key Result

Extrauterine placental transfusion and physiology-based cord clamping in healthy newborns after caesarean delivery resulted in a median heart rate peaking at 169 bpm at 4 minutes.

Key Points

To describe the normal heart rate of healthy newborns ≥35+0 weeks’ gestation post-caesarean delivery with extrauterine placental transfusion.
Prospective observational study conducted at a single centre.
Newborns ≥35+0 weeks’ gestation delivered by caesarean section under regional anaesthesia were monitored.
Heart rate was recorded every second for 10 minutes using a dry-electrode ECG.
Included 89 newborns with a median heart rate of 164 bpm at 20 seconds and peaking at 169 bpm at 4 minutes.
Heart rate decreased gradually to 157 bpm by 10 minutes.
Cord clamping and placental delivery had no significant impact on heart rate.

Study Design

Type

Observational (n=89)

Multicenter

Structured PICO

Population

89 healthy newborns ≥35+0 weeks’ gestation delivered by caesarean delivery under regional anaesthesia, mean gestational age 39+3 weeks, mean birth weight 3649 g.

Intervention

Extrauterine placental transfusion and modified physiology-based cord clamping (PBCC) with heart rate monitoring using dry-electrode ECG (NeoBeat).

Outcome

Heart rate recorded every second for 10 minutessurrogate

This study provides the first description of normal heart rate quartiles for healthy newborns ≥35 weeks’ gestation in the first 10 minutes after caesarean delivery with extrauterine placental transfusion and physiology-based cord clamping.

Abstract

Objective To describe the normal heart rate (HR) of healthy newborns ≥35+0 weeks’ gestation in the first 10 min after caesarean delivery (CD) with extrauterine placental transfusion, using dry-electrode ECG (NeoBeat). Design Single-centre, prospective observational study. Setting Norwegian County Hospital. Patients Newborns ≥35+0 weeks’ gestation delivered by CD under regional anaesthesia were eligible for inclusion. Newborns delivered by CD under general anaesthesia, or who needed medical intervention, were excluded. Interventions NeoBeat was attached to the newborn’s chest immediately following delivery. The placenta was delivered without cord clamping after 60–90 s and transferred with the newborn to a resuscitation table. Modified physiology-based cord clamping (PBCC) was performed. Main outcome measures HR was recorded every second for 10 min. HR quartiles were calculated. Events possibly influencing HR were annotated using Liveborn Observation App. Results 89 newborns with a mean (SD) gestational age of 39+3 weeks (10 days) and birth weight of 3649 (536) g were included. Median (IQR) HR was 164 (117–176) and 169 (145–186) beats per minute at 20 s and 30 s, respectively, peaking at 169 (152–183) beats per minute at 4 min and then slowly decreasing to 157 (146–167) beats per minute at 10 min. HR was not significantly affected by intact-cord blood sampling (mean difference=5.4 (95% CI −1.4 to 12.1)), placental delivery (mean difference=0.7 (95% CI −3.5 to 4.9)) or cord clamping (mean difference =−0.6 (95% CI −2.1 to 0.9)). Conclusions This report describes, for the first time, HR quartiles for healthy newborns ≥35 0 weeks’ gestation from 15 s to 20 s and up to 10 min after CD with extrauterine placental transfusion and PBCC.