The relation between given volume and heart rate during newborn resuscitation

J. E. Linde, J. Schulz, J. M. Perlman, K. Øymar, L. Blacy, H. Kidanto, H. L. Ersdal

Research output: Contribution to journalArticlepeer-review

32 Citations (Scopus)

Abstract

Background During delivery room resuscitation of depressed newborns, provision of appropriate tidal volume (TV) with establishment of functional residual capacity (FRC) is essential for circulatory recovery. Effective positive pressure ventilation (PPV) is associated with a rapid increase in heart rate (HR). The relationship between delivery of TV and HR responses remains unclear. Objectives The study objectives were to determine (1) the relationship between a given TV during initial PPV and HR responses of depressed newborns, and (2) the optimal delivered TV associated with a rapid increase in HR. Methods In a Tanzanian rural hospital, ventilation and ECG signals were recorded during neonatal resuscitation and stored in Neonatal Resuscitation Monitors. Resuscitators without positive end-expiratory pressure were used for PPV. No oxygen was used. Perinatal events were observed and recorded by research assistants. Results 215 newborns of gestational age 37.3 ± 1.9 weeks and birth weight 3115 ± 579 g were included. There was a non-linear relationship between delivered TV and HR increase. TV of 9.3 ml/kg produced the largest increase in HR during PPV. Frequent interruptions of PPV sequences to provide stimulation/suctioning occurred in all cases and were associated with further HR increases, especially for newborns with initial HR < 100 beats/minute. Conclusions There was a consistent positive relationship between HR increase and delivered TV. The unanticipated finding of a further increase in HR with PPV pauses to provide stimulation/suctioning suggests that most newborns were in primary rather than secondary apnea.

Original languageEnglish
Pages (from-to)80-86
Number of pages7
JournalResuscitation
Volume117
DOIs
Publication statusPublished - Aug 2017
Externally publishedYes

Keywords

  • Heart rate response
  • Neonatal resuscitation
  • Positive pressure ventilation
  • Resuscitation monitor
  • Tidal volume

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