ECG in the delivery room: fewer intubations but no mortality change

  • Shah BA & al.
  • Resuscitation
  • 05/08/2019

  • Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Introduction of ECG monitoring in the delivery room is associated with fewer endotracheal intubations, higher 5-minute Apgars, and other benefits.
  • However, use of chest compressions increased, and mortality remained unchanged.

Why this matters

  • The 2017 American Academy of Pediatrics neonatal resuscitation guidelines suggest ECG monitoring in the delivery room, and this unit evaluated outcomes before and after this implementation.

Key results

  • Compared with infants before ECG monitoring was introduced, those with monitoring had:
    • Lower endotracheal intubation rate: 35.5% vs 47.5%; aOR, 0.65 (P=.023);
    • Higher 5-minute Apgars: 7 vs 6 (P=.016);
    • Reduction in severe retinopathy of prematurity: aOR, 0.32 (P=.005); and
    • Increased odds of chest compressions: aOR, 3.59 (P=.009).
  • Mortality did not differ between before and after ECG introduction: 8.4% vs 8.8%; aOR, 1.58 (P=.167).

Study design

  • ECG was done in 369 infants after it was introduced in 2017; the retrospective cohort of 263 infants received no monitoring (born 2015); all infants received positive pressure ventilation.
  • Funding: University of Oklahoma. 

Limitations

  • Not randomized.
  • Unrecognized confounding possible.