Abstract
Introduction
Studies on neonatal cardiorespiratory transition are important in guiding resuscitation guidelines. The objectives were to determine the immediate transitional changes of heart rate (HR) and saturation values in neonates who received various levels of resuscitation and the level of agreement between NeoBeat and pulse oximetry.
Methods
High-risk deliveries (n = 63) in a low resource setting were observed using pulse oximetry and NeoBeat in three groups: comfortably breathing receiving no resuscitation, labored breathing receiving oxygen only, and apneic receiving bag mask ventilation (BMV) plus oxygen. Data were analyzed by time of birth and compared for levels of agreement.
Results
Comfortably breathing neonates had initial saturation values (86 ± 13%) with relatively high initial HRs (177 ± 19 beats per minute [bpm]). For neonates receiving oxygen only, 43% reached target saturation goals despite an initial HR of 150 ± 21 bpm, while the BMV group had 73% reach target saturation goals with an initial HR of 88 ± 40 bpm. Bland-Altman revealed low bias in all groups and progressively wider lines of agreement as neonates required more resuscitation. In the BMV group, pulse oximetry often displayed a lower HR than NeoBeat at lower mean HR values.
Conclusions
Elevated early saturation values and higher HRs in comfortably breathing neonates may be indicative of a seamless cardiorespiratory adaptation. For neonates requiring resuscitation, oxygen alone without positive end-expiratory pressure may delay respiratory transitioning, as evidenced by low oxygen saturations at 5 min, whereas a higher percentage of neonates receiving BMV with oxygen met target saturation goals.
Keywords: Neonatal adaptation, Newborn resuscitation, Oxygen saturation
Introduction
Transition from fetal to neonatal life is a complex process involving significant cardiorespiratory changes. Initiation of breathing leads to the establishment of functional residual capacity and the reduction in pulmonary vascular resistance, both of which aid in gas exchange [1]. Studies on this normal physiologic transition at birth [2] have guided international recommendations for resuscitation [3].
These recommendations are less applicable in the low resource setting (LRS) as blenders and pulse oximeters are not commonly available. Larsson et al. [4] demonstrated in Uganda that neonates >34 weeks of GA receiving bag mask ventilation (BMV) with no oxygen had saturation values <80% at 10 min of life. This is below the Neonatal Resuscitation Program (NRP) goal saturation value of ≥80% by 5 min [5]. Low saturations at 5 min have been associated with severe intraventricular hemorrhage in neonates <32 weeks of GA [6]. Therefore, studies investigating physiologic transition in both preterm and term neonates in a population without blended oxygen are needed to guide recommendations in the LRS.
Oxygen saturation in the delivery room is determined by pulse oximetry, which, in addition, provides a measure of heart rate (HR). In an initial report analyzing HR utilizing pulse oximetry, it was suggested that some healthy preterm and term neonates with normal tone may have an HR <100 bpm in the first 2 min of life and that this should not be an indicator for immediate ventilation [7]. Subsequent studies utilizing electrocardiography (ECG) have shown that this is rarely observed in healthy neonates [8, 9]. One study showed that pulse oximetry underestimates HR compared to the dry- and gel-electrode ECG in neonates receiving resuscitation [10]. These findings identify a gap in knowledge as it relates to the levels of agreement between pulse oximetry and ECG based on neonates receiving varying degrees of resuscitation.
We hypothesize that high-risk neonates (preterm and term combined) requiring some form of resuscitation (oxygen only or BMV with oxygen) will have a lower initial saturation and HR values compared to comfortably breathing neonates and will correct with resuscitation. The study objectives were (1) to observe the immediate transitional changes of HR and saturation values upon delivery and measure how various levels of resuscitation impact them and (2) to determine the level of agreement between NeoBeat and pulse oximetry in neonates with different resuscitation needs.
Methods
Study Setting
This study was conducted at Kilimanjaro Christian Medical Centre (KCMC) which is a zonal referral teaching hospital in Northern Tanzania. Delivery room resuscitations are conducted primarily by labor and delivery midwives. Midwives determine if deliveries are high risk and may require additional support from pediatric residents based on common indications including prematurity (<37 weeks), pre-eclampsia, and fetal distress. Delayed cord clamping (DCC) greater than 1 min and immediate drying/stimulation are standard of care. However, immediate cord clamping with stimulation may occur in apneic neonates. All high-risk neonates are brought to a resuscitation room for observation and/or intervention. The resuscitation room contains three radiant warmers, resuscitation equipment, pulse oximeters (Rad-G, Masimo), and dry-electrode ECG devices (NeoBeat, Laerdal Global Health). BMV, if needed, is performed using self-inflating resuscitators ± a reservoir that do not have the capacity to provide end-expiratory pressure or measure delivered inflating pressure. In general, resuscitators are connected to a 100% oxygen source set to 5 L with no access to a blender. Continuous positive airway pressure (CPAP) and intubation are unavailable in the resuscitation room. Therefore, one-liter nasal cannula with 100% oxygen and short nasal prongs is commonly used for neonates with labored breathing and is routinely started prior to 5 min of life.
Protocol
A local research assistant (JC) intermittently observed high-risk deliveries on both the day and night shift from July 2024 to August 2025. Upon arrival to the warmer, the research assistant placed both a NeoBeat around the abdomen and a pulse oximeter with a reusable probe on an upper extremity (85% pre-ductal). The research assistant used a data sheet to record general characteristics (birthweight, gestational age) and interventions performed in the delivery room (stimulation, BMV). Gestational age was determined by maternal-reported last menstrual period and confirmed by ultrasound on admission to KCMC. The research assistant did not actively participate in the resuscitations nor were the previously established resuscitation practices at KCMC changed for this study. Neonates were divided into three subcategories: comfortably breathing receiving no resuscitation, labored breathing receiving oxygen only, and apneic receiving BMV.
Data Collection and Analysis
All collected data were de-identified. Delivery room interventions were recorded in REDCap electronic data capture tools hosted at Weill Cornell Medicine. NeoBeat data were securely transferred to a cloud storage system (Laerdal Medical) and downloaded for subsequent analysis. Pulse oximetry data were downloaded to a secure research computer using the Trace program (Masimo) and transferred to Weill Cornell Medicine for subsequent analysis. The research team compared time of birth as manually recorded by the research assistant with times provided by continuous NeoBeat and pulse oximetry data in order to determine HR and oxygen saturation values at each minute of life ± 60 s. Only recordings that matched the manually recorded time of birth were used for analysis. Data were analyzed from time of birth which was defined as the time the neonate was delivered. Data were analyzed with paired and unpaired T-Tests, chi-square analysis, Fisher’s exact test, Bland-Altman plots, and correlation coefficients.
Ethics
This project was approved by the National Institute of Medical Research in Tanzania (NIMR/HQ/R.8a/Vol.IX/4566, NIMR/HQ/R.8a/Vol.IX/4417). Written informed consent was not required per the Ethics Committee at Kilimanjaro Christian Medical Centre (#2629).
Results
There were 63 neonates who had pulse oximetry (n = 60) or NeoBeat (n = 43) recordings that matched the observed time of birth. Fifteen (24%) were <32 weeks of gestational age, 24 (38%) were 32–36 weeks, and 24 (38%) were ≥37 weeks. Of the 63 neonates, 20 (32%) needed no resuscitation, 27 (43%) oxygen only, and 16 (25%) BMV with oxygen attached. There was no difference in birthweights or gestational ages between these three groups of neonates (Table 1). DCC was performed in 100% of neonates who did not receive resuscitation, 85% in neonates resuscitated with oxygen, and 56% in neonates who received BMV.
Table 1.
General characteristics and initial saturation/HR values and 15 min of life in comfortably breathing neonates, neonates receiving oxygen only, and neonates receiving BMV
| Resuscitation | Birthweight, kg | Gestational age, weeks | Initial saturation, % | 15 min saturation, % | Saturation change initial to 15 min, % | Initial HR, bpm | 15-min HR, bpm | HR change initial to 15 min, bpm |
|---|---|---|---|---|---|---|---|---|
| Comfortably breathing | 2.4±0.8 | 35.7±2.7 | 86.3±12.8 | 94.5±8.2 | ↑ 10.9±10.9* | 176.6±18.7 | 151.5±19.4 | -- |
| Oxygen only | 2.2±1.1 | 33.8±4.0 | 64.3±17.9 | 92.7±12.5 | ↑ 27.5±15.8* | 150±20.8 | 158.2±19.9 | -- |
| BMV | 2.5±1.3 | 34.9±3.9 | 51.5±29.9% | 90.9±12.2% | ↑ 42.7±24.2* | 87.7±40.9 | 165.6±23.3 | ↑ 69.7±47.1* |
--, no statistical difference.
*p < 0.05.
Pulse Oximetry
Initial saturation values were significantly higher in neonates who were comfortably breathing requiring no resuscitation (86.3 ± 12.8%) as compared to both neonates who received oxygen only (64.3 ± 17.9%) or BMV (51.5 ± 29.9%) (both p ≤ 0.01) (shown in Fig. 1–3). These significant differences in saturation values between the comfortably breathing and resuscitation groups resolved by 6 min (oxygen group) and 3 min (BMV group). There was no difference in initial oxygen saturations between the oxygen only and BMV groups (p = 0.31). Most neonates reached the NRP saturation target goal of ≥80% by 5 min of life in the BMV group (73%) as compared to the oxygen only group (43%, p = 0.11). For comfortably breathing neonates, 90% reached the NRP goal. At the same 5-min mark, only one neonate in both the BMV and oxygen only group and none in the no resuscitation group had an HR <100 bpm. By 15 min, all three groups had a significant increase in saturations from their initial values on paired t-testing (Table 1).
Fig. 1.
Box plot of saturation (a) and ECG HR (b) values over the first 15 min of life in comfortably breathing neonates.
Fig. 3.
Box plot of saturation (a) and ECG HR (b) values over the first 15 min of life in neonates receiving BMV.
Fig. 2.
Box plot of saturation (a) and ECG HR (b) values over the first 15 min of life in neonates receiving oxygen only.
NeoBeat
As determined by ECG, HRs were significantly higher in neonates who were comfortably breathing (176.6 ± 18.7 bpm) compared to both the oxygen only (150 ± 20.8 bpm, p = 0.04) and BMV group (87.7 ± 40.9 bpm, p = 0.002). These differences in HR between the comfortably breathing and resuscitation groups resolved by 3 min (oxygen group) and 4 min (BMV group). Of note there were no HRs <100 bpm as determined by pulse oximetry or NeoBeat in the comfortably breathing group. Neonates who received oxygen only also had higher initial HRs than the BMV group (p = 0.003) which resolved by 2 min. Mean HRs in the BMV group increased from 87.7 to ≥100 bpm by 2 min. On paired analysis, only the BMV group had a significant increase in HR from initial to 15 min of life (p = 0.02) (Table 1).
Determination of HR by Pulse Oximetry versus NeoBeat
In all three groups, there were a significantly greater number of NeoBeat recordings at 1 min compared to pulse oximetry recordings (all p ≤ 0.03). The NeoBeat detected an HR within 20.7 ± 18.2 s from placement. On Bland-Altman analysis, the bias between paired Masimo and NeoBeat recordings was low at 1.17, −0.69, and −4.68 for the comfortably breathing, oxygen only, and BMV groups, respectively (shown in Fig. 4). The corresponding correlation coefficients were 0.98, 0.83, and 0.78, respectively (all p < 0.001). Lines of agreement became progressively wider as neonates required more resuscitation. In the BMV group, pulse oximetry often displayed a lower HR than NeoBeat at lower mean HR values but not in the other groups.
Fig. 4.
Bland-Altman plots of pulse oximetry versus NeoBeat HRs in comfortably breathing neonates (a), neonates receiving oxygen only (b), and neonates receiving BMV (c). Solid line represents mean bias and dashed lines the upper and lower levels of agreement.
Discussion
This paper describes important oxygen saturation and HR transitional changes that occur in high-risk neonates receiving varying levels of resuscitation as compared to comfortably breathing neonates who received no resuscitation in the LRS. Comfortably breathing neonates had both higher initial saturation values and HRs compared to neonates receiving oxygen or BMV. Neonates receiving oxygen only without end-expiratory pressure were slower to reach NRP saturation goals than neonates resuscitated with BMV connected to oxygen. When comparing HR readings as determined by NeoBeat vs. pulse oximetry, levels of agreement were comparable except in neonates receiving BMV.
With regard to pulse oximetry, all mean saturation values in comfortably breathing neonates were above the NRP target saturation goals. We speculate that this reflects a rapid decrease in pulmonary vascular resistance and early establishment of functional residual capacity in the setting of a robust cry. This may also reflect the impact of DCC as previous studies have demonstrated an association with higher oxygen saturations in spontaneously breathing neonates >37 weeks of GA [11, 12].
For all neonates requiring resuscitation, blended oxygen has been recommended by NRP [5] and ILCOR [3] with different starting values based on GA and close titration using pulse oximetry. However, in the LRS, many institutions do not have the capability to blend oxygen [13] and do not have pulse oximeters. Specifically, at KCMC, blended oxygen is not available. Therefore, 100% oxygen is used for neonates receiving BMV. Although saturations started low in these neonates, mean saturations values were above 80% by 5 min in most cases. In contrast, Larsson et al. [4] demonstrated that neonates resuscitated with BMV and room air had median saturation values below 80% through 10 min despite median HRs always being >100 bpm. Given this discrepancy, further studies should investigate if there is a benefit to providing 100% oxygen at the time of BMV with removal when saturations are >80%. Alternatively, experimental studies have shown that titration may be feasible without a blender by adjusting the oxygen flow rate administered through the self-inflating bag [14, 15]. However, the risk/benefits of oxygen stress need to be considered [6, 16–18], especially in near term and term neonates where 100% oxygen has been associated with higher mortality [17] and delay to first cry [19, 20].
Neonates who were resuscitated with oxygen only had saturations below target range and only reached a mean saturation of ≥80% by 7 min despite having initial HRs similar to comfortably breathing neonates. At KCMC, CPAP is not available in the resuscitation room; therefore, support for labored breathing is delivered via one-liter nasal cannula. The lack of positive pressure in neonates requiring intermediate resuscitation likely delays the establishment in functional residual capacity, which is necessary for adequate gas exchange [1]. However, the time of oxygen initiation could not be reliably determined. Therefore, it is unclear whether the delay in improving oxygenation was due to the underlying clinical condition or the type and time of support provided.
The determination of HR in the delivery room is influenced by method of detection. For example, pulse oximetry nomograms may be inaccurate in the first few minutes of life given their dependence on perfusion for measurement. Multiple studies have indicated that ECG is more reliable than pulse oximetry with the latter more often displaying bradycardia [8, 21, 22] in the first couple minutes [8, 9]. Dawson et al. [7], using pulse oximetry in both preterm and term neonates, showed a median HR of 96 bpm at 1 min, 139 at 2 min, and 163 at 5 min for neonates not receiving resuscitation. In our study which included preterm neonates, the NeoBeat in comfortably breathing neonates had a mean HR of 177 bpm at 1 min. This is consistent with data from Bjorland et al. [23] who described a median HR of 175 bpm at 1 min in healthy, term neonates. The mechanisms accounting for the relatively higher initial HR are unclear and warrant further investigation.
Notably, even neonates requiring oxygen had initial HRs of 150 bpm. The initial HR was lowest in those who required BMV at a mean value of 88 bpm and responded quickly with a rise in HR above 100 bpm suggesting effective ventilation. Another study in a high resource center demonstrated that in neonates receiving BMV only a minority (1/3) had an HR <100 bpm as measured by the NeoBeat. Upon video review, these neonates required BMV for insufficient respiratory effort [24]. In summary, when utilizing ECG as opposed to pulse oximetry, an HR <100 bpm does not reflect a normal physiologic state and should be an indication for intervention.
We consider the NeoBeat to be a valuable tool in conjunction to pulse oximetry in the LRS. Unlike traditional ECG machines, it is easy to apply, compact, and does not require consumable leads. Bush et al. [25] demonstrated that it was faster to apply and provide an HR than both pulse oximetry and three-lead ECG. In this study, Bland-Altman analysis revealed good reliability with pulse oximetry in comfortably breathing neonates and those requiring oxygen. Notably, discrepancies at lower mean HR values were noted in neonates requiring BMV. This is likely secondary to poor perfusion hindering reliable pulse oximetry readings. Therefore, the NeoBeat could be a valuable tool in determining cardiac status in these situations. This is similar to Rettedal et al. [10] study which found that in neonates receiving BMV, pulse oximetry displayed a lower HR reading than the NeoBeat up to 7 min. Additionally, in all three groups of our study, the NeoBeat detected an HR quicker than pulse oximetry which corroborates previous reports [10, 25].
Limitations
There are some limitations to our study. First, due to technical differences in device recording times, not all observed high-risk deliveries had both a NeoBeat and pulse oximetry recording that could be reliably correlated with the time of birth despite both devices being placed on all neonates. Second, time of birth was recorded in hour, minute, while the NeoBeat and pulse oximeter recorded in hour, minute, second. Therefore, there may be slight variability between recording time and second of life. Third, the timing of oxygen initiation was not precisely recorded but was noted to be within the first 5 min which limits interpretation of the oxygen only group. Fourth, due to small sample sizes, our data may have limited generalizability.
Conclusion
Elevated early saturation values coupled with relatively higher initial HRs in comfortably breathing neonates may be indicative of a rapid decrease in pulmonary vascular resistance and seamless cardiorespiratory adaptation. However, for neonates with labored breathing, oxygen alone without positive end-expiratory pressure may delay respiratory transitioning as evidenced by low oxygen saturations at 5 min and suggests the need for CPAP in the delivery room in this setting. Lastly, the NeoBeat coupled with pulse oximetry may facilitate provider decision-making as the NeoBeat detected both an HR quicker in all groups and a higher HR in neonates requiring BMV.
Statement of Ethics
This study protocol was reviewed and approved by National Institute of Medical Research in Tanzania, Approval No. NIMR/HQ/R.8a/Vol.IX/4566 and NIMR/HQ/R.8a/Vol.IX/4417. Written informed consent was not required as per the Ethics Committee at Kilimanjaro Christian Medical Centre (# 2629).
Conflict of Interest Statement
The authors have no conflicts of interest to disclose.
Funding Sources
This work was supported in part by Thrasher Research Fund (TRF 234854-01) and Bloomberg Philanthropies. REDCap access is supported by institutional grant funding (CTSC GRANT UL1 TR002384). The funding sources had no role in the design, data collection, data analysis, and reporting of this study.
Author Contributions
Drs. Emily Ahn and Jeffrey Perlman conceptualized and designed the study/methodology, sought out funding acquisition, provided resources, conducted project administration and supervision, were responsible for data curation, performed formal data analysis, and drafted the original manuscript with visualization. Drs. Jackline Cypriane and Aisa Shayo and midwife Ester Ngowi assisted with study design/methodology, conducted investigation, and completed manuscript revisions/edits. All authors critically reviewed the manuscript for important intellectual content, revised the manuscript, approved the final manuscript as submitted, and agreed to be accountable for all aspects of the work.
Funding Statement
This work was supported in part by Thrasher Research Fund (TRF 234854-01) and Bloomberg Philanthropies. REDCap access is supported by institutional grant funding (CTSC GRANT UL1 TR002384). The funding sources had no role in the design, data collection, data analysis, and reporting of this study.
Data Availability Statement
All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.
References
- 1. Van Vonderen JJ, Roest AAW, Siew ML, Walther FJ, Hooper SB, Te Pas AB. Measuring physiological changes during the transition to life after birth. Neonatology. 2014;105(3):230–42. [DOI] [PubMed] [Google Scholar]
- 2. Dawson J, Kamlin COF, Vento M, Wong C, Cole TJ, Donath SM, et al. Defining the reference range for oxygen saturation for infants after birth. Pediatrics. 2010;125(6):e1340–47. [DOI] [PubMed] [Google Scholar]
- 3. Liley HG, Weiner GM, Wyckoff MH, Rabi Y, Schmölzer GM, De Almeida MF, et al. Neonatal life Support: 2025 International Liaison Committee on resuscitation consensus on science with treatment recommendations. Circulation. 2025;152(16_Suppl l_1):S165–04. [DOI] [PubMed] [Google Scholar]
- 4. Larsson M, Myrnerts Höök S, Mpamize A, Tylleskär T, Lubulwa C, Trevisanuto D, et al. Oxygen saturation after birth in resuscitated neonates in Uganda: a video-based observational study. BMJ Paediatr Open. 2022;6(1):e001225. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Textbook of neonatal resuscitation. 8th edAmerican Academy of Pediatrics; 2021. [Google Scholar]
- 6. Oei JL, Finer NN, Saugstad OD, Wright IM, Rabi Y, Tarnow-Mordi W, et al. Outcomes of oxygen saturation targeting during delivery room stabilisation of preterm infants. Arch Dis Child Fetal Neonatal Ed. 2018;103(5):446–54. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Dawson J, Kamlin C, Wong C, Te Pas A, Vento M, Cole T, et al. Changes in heart rate in the first minutes after birth. Arch Dis Child Fetal Neonatal Ed. 2010;95(3):F177–81. [DOI] [PubMed] [Google Scholar]
- 8. Van Vonderen JJ, Hooper SB, Kroese JK, Roest AAW, Narayen IC, Van Zwet EW, et al. Pulse oximetry measures a lower heart rate at birth compared with electrocardiography. J Pediatr. 2015;166(1):49–53. [DOI] [PubMed] [Google Scholar]
- 9. Linde JE, Schulz J, Perlman JM, Øymar K, Francis F, Eilevstjønn J, et al. Normal newborn heart rate in the first five minutes of life assessed by dry-electrode electrocardiography. Neonatology. 2016;110(3):231–7. [DOI] [PubMed] [Google Scholar]
- 10. Rettedal S, Eilevstjønn J, Kibsgaard A, Kvaløy JT, Ersdal H. Comparison of heart rate feedback from dry-electrode ECG, 3-Lead ECG, and pulse oximetry during newborn resuscitation. Children. 2021;8(12):1092. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11. Smit M, Dawson JA, Ganzeboom A, Hooper SB, Van Roosmalen J, Te Pas AB. Pulse oximetry in newborns with delayed cord clamping and immediate skin-to-skin contact. Arch Dis Child Fetal Neonatal Ed. 2014;99(4):F309–14. [DOI] [PubMed] [Google Scholar]
- 12. Padilla-Sánchez C, Baixauli-Alacreu S, Cañada-Martínez AJ, Solaz-García Á, Alemany-Anchel MJ, Vento M. Delayed vs immediate cord clamping changes oxygen saturation and heart rate patterns in the first minutes after birth. J Pediatr. 2020;227:149–56.e1. [DOI] [PubMed] [Google Scholar]
- 13. Herrod SK, Stevenson A, Vaucher YE, Lambert SR, Isenberg SJ, Yap VL, et al. Oxygen management among infants in neonatal units in Sub-Saharan Africa: a cross-sectional survey. J Perinatol. 2021;41(11):2631–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14. Thio M, Van Kempen L, Rafferty AR, Bhatia R, Dawson JA, Davis PG. Neonatal resuscitation in resource-limited settings: titrating oxygen delivery without an oxygen blender. J Pediatr. 2014;165(2):256–60.e1. [DOI] [PubMed] [Google Scholar]
- 15. Trevisanuto D, Dal Cengio V, Doglioni N, Cavallin F, Zanardo V, Parotto M, et al. Oxygen delivery using a neonatal self-infalting resuscitation bag: effect of oxygen flow. Pediatrics. 2013;131(4):e1144–149. [DOI] [PubMed] [Google Scholar]
- 16. Oei JL, Kirby A, Travadi J, Davis P, Wright I, Ghadge A, et al. Targeted oxygen for initial resuscitaiton of preterm infants the TORPIDO 30/60 randomized clinical trial. JAMA. 2026;335(6):523–30. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17. Saugstad OD, Ramji S, Soll RF, Vento M. Resuscitation of newborn infants with 21% or 100% oxygen: an updated systematic review and meta-analysis. Neonatology. 2008;94(3):176–82. [DOI] [PubMed] [Google Scholar]
- 18. Saugstad OD, Kapadia V, Oei JL. Oxygen in the first minutes of life in very preterm infants. Neonatology. 2021;118(2):218–24. [DOI] [PubMed] [Google Scholar]
- 19. Saugstad OD, Rootwelt T, Aalen O. Resuscitation of asphyxiated newborn infants with room air or oxygen: an international controlled trial: the resair 2 Study. Pediatrics. 1998;102(1):1–7. [DOI] [PubMed] [Google Scholar]
- 20. Vento M, Asensi M, Sastre J, García-Sala F, Pallardó FV, Viña J. Resuscitation with room air instead of 100% oxygen prevents oxidative stress in moderately asphyxiated term neonates. Pediatrics. 2001;107(4):642–7. [DOI] [PubMed] [Google Scholar]
- 21. Mizumoto H, Tomotaki S, Shibata H, Ueda K, Akashi R, Uchio H, et al. Electrocardiogram shows reliable heart rates much earlier than pulse oximetry during neonatal resuscitation. Pediatr Int. 2012;54(2):205–7. [DOI] [PubMed] [Google Scholar]
- 22. Katheria A, Rich W, Finer N. Electrocardiogram provides a continuous heart rate faster than oximetry during neonatal resuscitation. Pediatrics. 2012;130(5):e1177–81. [DOI] [PubMed] [Google Scholar]
- 23. Bjorland PA, Ersdal HL, Eilevstjønn J, Øymar K, Davis PG, Rettedal SI. Changes in heart rate from 5 s to 5 min after birth in vaginally delivered term newborns with delayed cord clamping. Arch Dis Child Fetal Neonatal Ed. 2021;106(3):311–5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24. Kibsgaard A, Ersdal H, Kvaløy JT, Eilevstjønn J, Rettedal S. Newborns requiring resuscitation: two thirds have heart rate ≥100 beats/minute in the first minute after birth. Acta Paediatr. 2023;112(4):697–705. [DOI] [PubMed] [Google Scholar]
- 25. Bush JB, Cooley V, Perlman J, Chang C. NeoBeat offers rapid newborn heart rate assessment. Arch Dis Child Fetal Neonatal Ed. 2021;106(5):550–2. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.
