Cardiorespiratory Transitioning at Birth During Varying Levels of Resuscitation and The Role of Dry-Electrode ECG (NeoBeat) and Pulse Oximetry in a Low Resource Setting.

Introduction: Studies on neonatal cardiorespiratory transition are important in guiding resuscitation guidelines. The objectives were to determine the immediate transitional changes of heart rate (HR) and saturation values in neonates who received various levels of resuscitation and the level of agreement between NeoBeat and pulse oximetry. Methods: High risk deliveries (n=63) in a low resource setting were observed using pulse oximetry and NeoBeat in three groups: comfortably breathing receiving no resuscitation, labored breathing receiving oxygen only, and apneic receiving bag mask ventilation (BMV) plus oxygen. Data were analyzed by time of birth and compared for levels of agreement. Results: Comfortably breathing neonates had initial saturation values (86±13%) with relatively high initial HRs (177±19 beats per minute (bpm)). For neonates receiving oxygen only, 43% reached target saturation goals despite an initial HR of 150±21 bpm; while the BMV group had 73% reach target saturation goals with an initial HR of 88±40 bpm. Bland Altman revealed low bias in all groups and progressively wider lines of agreement as neonates required more resuscitation. In the BMV group, pulse oximetry often displayed a lower HR than NeoBeat at lower mean HR values. Conclusions: Elevated early saturation values and higher HRs in comfortably breathing neonates may be indicative of a seamless cardiorespiratory adaptation. For neonates requiring resuscitation, oxygen alone without positive end expiratory pressure may delay respiratory transitioning as evidenced by low oxygen saturations at 5 minutes whereas neonates receiving effective BMV with oxygen, a higher percentage met target saturation goals.