Anne Lee Solevåg

Background: Heart rate (HR) is considered the main vital sign in newborns during perinatal transition, with a threshold of 100 beats per minute (bpm), below which, intervention is recommended. However, recent changes in delivery room management, including delayed cord clamping, are likely to have influenced normal HR transition. Objective: To summarize the updated knowledge about the factors, including measurement methods, that influence HR in newborn infants immediately after birth. Additionally, this paper provides an overview of delivery room HR as a prognostic indicator in different subgroups of newborns. Methods: We searched PubMed, EMBASE, and Google Scholar with the terms infant, heart rate, delivery room, resuscitation, pulse oximetry, and electrocardiogram. Results: Seven studies that described HR values in newborn infants immediately after birth were included. Pulse oximetry-derived HR percentiles after immediate cord clamping may not be applicable to the current practice of delayed cord clamping and the increasing use of delivery room electrocardiograms. Mask ventilation may adversely affect HR, particularly in premature and non-asphyxiated infants. Prolonged bradycardia is a negative prognostic factor, especially if combined with hypoxemia in infants <32 weeks of gestation. Conclusions: HR assessment in the delivery room remains important. However, the cardiopulmonary transition is affected by delayed cord clamping, gestational age, and underlying conditions.

Aim To examine whether biochemical surveillance vs clinical observation of term infants with prolonged rupture of membranes as a risk factor for early‐onset sepsis is associated with differences in patient trajectories in maternity and neonatal intensive care units. Methods A retrospective study of live‐born infants with gestational age ≥ 37 + 0 weeks born after prolonged rupture of membranes (≥24 h) in four Norwegian hospitals 2017–2019. Two hospitals used biochemical surveillance, and two used predominantly clinical observation to identify early‐onset sepsis cases. Results The biochemical surveillance hospitals had more C‐reactive protein measurements ( p < 0.001), neonatal intensive care unit admissions ( p < 0.001) and antibiotic treatment ( p < 0.001). Hospitals using predominantly clinical observation initiated antibiotic treatment earlier in infants with suspected early‐onset sepsis ( p = 0.04) but not in infants fulfilling early‐onset sepsis diagnostic criteria ( p = 0.09). There was no difference in antibiotic treatment duration ( p = 0.59), fraction of infants fulfilling early‐onset sepsis diagnostic criteria ( p = 0.49) or length of hospitalisation ( p = 0.30), and no early‐onset sepsis‐related adverse outcomes. Conclusion The biochemical surveillance hospitals had more C‐reactive protein measurements, but there was no difference in antibiotic treatment duration, early‐onset sepsis cases, length of hospitalisation or adverse outcomes. Personnel resources needed for clinical surveillance should be weighed against the limitation of potentially painful procedures.