Key result
Novel heart rate sensors reduce invasiveness but increase artifacts, while standard ECG delays reliable signals ~1-2 minutes.
Why the study?
Heart rate is the most important clinical indicator to evaluate newborn status, but existing methods to detect HR have limitations affecting accuracy and timeliness.
How do established and novel methods for detecting heart rate in newborn infants compare to pulse oximetry or ECG in terms of accuracy and speed?
Systematic Review (n=25)
How do established and novel methods for detecting heart rate in newborn infants compare to pulse oximetry or ECG in terms of accuracy and speed?
Existing methods for neonatal heart rate monitoring are either inaccurate or delayed, emphasizing the need for improved technological solutions at birth.
Current HR methods show accuracy and latency shortfalls that may affect resuscitation decisions; leaves open need for validated rapid non-invasive alternatives.
BACKGROUND: Around 10% of newborn infants require assistance during transition after birth. Heart rate (HR) is the most important clinical indicator to evaluate the clinical status of a newborn. AIM: Our study aimed to review all established and novel methods to detect HR in babies giving special consideration to non-invasive techniques. METHODS: We performed a systematic literature search on the following databases: MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL. The inclusion criteria were studies on methods to detect HR in both term and preterm infants in comparison to one of the current gold standards: pulse oximetry (PO) or electrocardiography (ECG) published in the last 15 years. Two independent reviewers screened titles and abstracts for eligibility. Data extracted in an Excel table were analysed to produce a narrative review structured around the type of monitoring, identified obstacles in use, as well as methods to overcome these limitations. RESULTS: The search revealed 649 studies after duplicates were removed. Full article analysis was performed on 26 studies of which 25 met the inclusion criteria. Well established methods such as auscultation and palpation, although rapid and easily available, have been shown to be inaccurate. ECG and PO were both more precise but the delay in obtaining a reliable HR signal from birth often exceeded 1-2 min. Novel sensors offered the advantages of minimally obtrusive technologies but have limitations mainly due to movement artefact, bad sensor coupling, intermittent measurement, and poor-quality recordings. CONCLUSIONS: The limitations of existing methods have a potential impact on short- and long-term morbidity and mortality outcomes. The development of a technological solution to determine HR accurately and quickly in babies at birth has immense implications for further research and can guide interventions, such as placental transfusion and resuscitation.
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Anton et al. (2019) conducted a systematic review in Newborn infants requiring heart rate monitoring (n=25). Novel and established heart rate monitoring methods vs. Pulse oximetry or electrocardiography was evaluated on Accuracy and delay in obtaining a reliable HR signal. Novel heart rate sensors offer minimally obtrusive monitoring but suffer from artifacts, while precise standard methods like ECG and pulse oximetry often delay reliable signals by 1-2 minutes.
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