Cardiorespiratory Monitoring during Neonatal Resuscitation for Direct Feedback and Audit

Abstract

Neonatal resuscitation is one of the most frequently performed procedures, and it is often successful if the ventilation applied is adequate. Over the last decade, interest in seeking objectivity in evaluating the infant's condition at birth or the adequacy and effect of the interventions applied has markedly increased. Clinical parameters such as heart rate, color, and chest excursions are difficult to interpret and can be very subjective and subtle. The use of ECG, pulse oximetry, capnography, and respiratory function monitoring can add objectivity to the clinical assessment. These physiological parameters, with or without the combination of video recordings, can not only be used directly to guide care but also be used later for audit and teaching purposes. Further studies are needed to investigate whether this will improve the quality of delivery room management. In this narrative review, we will give an update of the current developments in monitoring neonatal resuscitation.

Keywords: ECG; neonate; pulse oximetry; respiratory function monitor; resuscitation; video.

Figure 1

Recording of a preterm infant receiving positive pressure ventilation. The tracing shows pressure (red), flow (green), expiratory volume (blue), and pulse rate (red). The blue arrow points a part of the volume entering the oropharynx at the start of the inflation. The green arrow points at the part of volume entering the lungs when the pressure time integral is large enough to overcome the resistance of the glottis and upper airway.

Figure 2

Recording showing a respiratory tracing showing flow, pressure, and capnography in waveforms. During positive pressure ventilation (PPV), CO₂ goes back to 0 during most of the inflations. During spontaneous breathing in continuous positive airway pressure (CPAP) CO₂ does not go back to 0 due to small tidal volumes and stasis in the sensor.