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Article

Impact of Heart Rate Monitoring Using Dry-Electrode ECG Immediately After Birth on Time to Start Ventilation: A Randomized Trial

by
Siren Rettedal
1,2,*,
Amalie Kibsgaard
1,
Frederikke Buskov
1,
Joar Eilevstjønn
3,
Vilde Kolstad
1,
Jan Terje Kvaløy
4,5,
Peder Aleksander Bjorland
6,7,
Hanne Pike
2,6,
Joanna Haynes
1,
Thomas Bailey Tysland
8,
Peter G. Davis
9 and
Hege Ersdal
1,2
1
Department of Simulation-Based Learning, Stavanger University Hospital, 4068 Stavanger, Norway
2
Faculty of Health Sciences, University of Stavanger, 4036 Stavanger, Norway
3
Strategic Research, Laerdal Medical, 4002 Stavanger, Norway
4
Department of Research, Section of Biostatistics, Stavanger University Hospital, 4068 Stavanger, Norway
5
Department of Mathematics and Physics, University of Stavanger, 4036 Stavanger, Norway
6
Department of Pediatrics, Stavanger University Hospital, 4068 Stavanger, Norway
7
Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
8
Department of Neurology, Stavanger University Hospital, 4068 Stavanger, Norway
9
The Royal Women’s Hospital, University of Melbourne, Parkville, Melbourne, VIC 3052, Australia
*
Author to whom correspondence should be addressed.
Children 2025, 12(8), 1082; https://doi.org/10.3390/children12081082
Submission received: 18 July 2025 / Revised: 5 August 2025 / Accepted: 14 August 2025 / Published: 18 August 2025
(This article belongs to the Special Issue Advances in Neonatal Resuscitation and Intensive Care)
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Abstract

Background/Objectives: Newborn heart rate is an integral part of resuscitation algorithms, but the impact of ECG monitoring on resuscitative interventions and clinical outcomes has been identified as a knowledge gap. The objective was to evaluate the impact of routine use of dry-electrode ECG in all newborns immediately after birth on time to start positive pressure ventilation (PPV) when indicated. Methods: We conducted a randomized clinical trial from June 2019 to November 2021 at Stavanger University Hospital, Norway. Dry-electrode ECG sensors were applied immediately after birth to all newborns ≥ 34 weeks’ gestation. Randomization determined whether the heart rate display was visible or masked. Time of birth was registered in an observation app. Time to start ventilation was calculated from video recordings. Results: In total, 7343 newborns ≥ 34 weeks’ gestation were enrolled, 4284 in the intervention and 3059 in the control group, and 3.7% and 3.8% received ventilation, respectively. In 171/275 (62%) of the newborns the exact time of birth and a video of the resuscitation were available, for 98 in the intervention and 73 in the control group. Ventilation was provided within 60 s to 44/98 (45%) in the intervention and 24/73 (33%) in the control group, p = 0.12. Time from birth to start of PPV was a median of 66 (44, 102) s in the intervention and 84 (49, 148) s in the control group, p = 0.058. Resuscitated newborns were apneic (74%) or breathing ineffectively (26%) at the start of PPV, and only 36% had a heart rate < 100 beats per minute. Conclusions: The use of dry-electrode ECG heart rate monitoring did not change the proportion of newborns that received ventilation within 60 s after birth, but early termination due to employee protests to video recordings rendered the trial inadequately powered to detect a difference. Breathing status was likely a more important determinant of starting ventilation than bradycardia.
Keywords: dry-electrode ECG; heart rate; heart rate monitoring; newborn resuscitation; positive pressure ventilation; newborn resuscitation algorithm dry-electrode ECG; heart rate; heart rate monitoring; newborn resuscitation; positive pressure ventilation; newborn resuscitation algorithm

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MDPI and ACS Style

Rettedal, S.; Kibsgaard, A.; Buskov, F.; Eilevstjønn, J.; Kolstad, V.; Kvaløy, J.T.; Bjorland, P.A.; Pike, H.; Haynes, J.; Tysland, T.B.; et al. Impact of Heart Rate Monitoring Using Dry-Electrode ECG Immediately After Birth on Time to Start Ventilation: A Randomized Trial. Children 2025, 12, 1082. https://doi.org/10.3390/children12081082

AMA Style

Rettedal S, Kibsgaard A, Buskov F, Eilevstjønn J, Kolstad V, Kvaløy JT, Bjorland PA, Pike H, Haynes J, Tysland TB, et al. Impact of Heart Rate Monitoring Using Dry-Electrode ECG Immediately After Birth on Time to Start Ventilation: A Randomized Trial. Children. 2025; 12(8):1082. https://doi.org/10.3390/children12081082

Chicago/Turabian Style

Rettedal, Siren, Amalie Kibsgaard, Frederikke Buskov, Joar Eilevstjønn, Vilde Kolstad, Jan Terje Kvaløy, Peder Aleksander Bjorland, Hanne Pike, Joanna Haynes, Thomas Bailey Tysland, and et al. 2025. "Impact of Heart Rate Monitoring Using Dry-Electrode ECG Immediately After Birth on Time to Start Ventilation: A Randomized Trial" Children 12, no. 8: 1082. https://doi.org/10.3390/children12081082

APA Style

Rettedal, S., Kibsgaard, A., Buskov, F., Eilevstjønn, J., Kolstad, V., Kvaløy, J. T., Bjorland, P. A., Pike, H., Haynes, J., Tysland, T. B., Davis, P. G., & Ersdal, H. (2025). Impact of Heart Rate Monitoring Using Dry-Electrode ECG Immediately After Birth on Time to Start Ventilation: A Randomized Trial. Children, 12(8), 1082. https://doi.org/10.3390/children12081082

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