Comparing peripheral limb and forehead vital sign monitoring in newborn infants at birth

Swamy, Suvvi K. Narayana; Stockwell, Simon J.; Liu, Chong; Henry, Caroline; Shipley, Lara; Ward, Carole; Mirahmadi, Siavash; Correia, Ricardo; Morgan, Stephen P.; Crowe, John A.; Sharkey, Don; Hayes-Gill, Barrie R.

Abstract

Background: To study the feasibility of measuring heart rate (HR) and oxygen saturation (SpO2) on the forehead, during newborn transition at birth, and to compare these measurements with those obtained from the wrist. Methods: Vital signs were measured and compared between forehead-mounted reflectance (remittance) photoplethysmography sensor (fhPPG) and a wrist-mounted pulse oximeter sensor (wrPO), from 20 enrolled term newborns born via elective caesarean section, during the first 10 min of life. Results: From the datasets available (n = 13), the median (IQR) sensor placement times for fhPPG, ECG and wrPO were 129 (70) s, 143 (68) s, and 159 (76) s, respectively, with data recorded for up to 10 min after birth. The success rate (percentage of total possible HR values reported once sited) of fhPPG (median = 100%) was higher compared to wrPO (median = 69%) during the first 6 min of life (P < 0.005). Both devices exhibited good HR agreement with ECG, achieving >95% agreement by 3 (fhPPG) and 4 (wrPO) min. SpO2 for fhPPG correlated with wrPO (r = 0.88), but there were significant differences in SpO2 between the two devices between 3 and 8 min (P < 0.005), with less variance observed with fhPPG SpO2. Conclusion: In the period of newborn transition at birth in healthy term infants, forehead measurement of vital signs was feasible and exhibited greater HR accuracy and higher estimated SpO2 values compared to wrist-sited pulse oximetry. Further investigation of forehead monitoring based on the potential benefits over peripheral monitoring is warranted. Impact: This study demonstrates the feasibility of continuously monitoring heart rate and oxygen saturation from an infant’s forehead in the delivery room immediately after birth. Significantly higher SpO2 measurements were observed from the forehead than the wrist during the transition from foetal to newborn life. Continuous monitoring of vital signs from the forehead could become a valuable tool to improve the delivery of optimal care provided for newborns at birth.

Citation

Swamy, S. K. . N., Stockwell, S. J., Liu, C., Henry, C., Shipley, L., Ward, C., Mirahmadi, S., Correia, R., Morgan, S. P., Crowe, J. A., Sharkey, D., & Hayes-Gill, B. R. (2024). Comparing peripheral limb and forehead vital sign monitoring in newborn infants at birth. Pediatric Research, https://doi.org/10.1038/s41390-024-03651-0

• Journal Article Type: Article
• Acceptance Date: Sep 20, 2024
• Online Publication Date: Oct 17, 2024
• Publication Date: Oct 17, 2024
• Deposit Date: Nov 20, 2024
• Publicly Available Date: Nov 20, 2024
• Journal: Pediatric Research
• Print ISSN: 0031-3998
• Electronic ISSN: 1530-0447
• Publisher: Nature Publishing Group
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1038/s41390-024-03651-0
• Public URL: https://nottingham-repository.worktribe.com/output/42209485
• Publisher URL: https://www.nature.com/articles/s41390-024-03651-0
• Additional Information: Received: 22 May 2024; Revised: 6 September 2024; Accepted: 20 September 2024; First Online: 17 October 2024; : Chong Liu, Caroline Henry, Lara Shipley, Carole Ward, Siavash Mirahmadi and Ricardo Correia have no conflicts of interest to declare. Suvvi K. Narayana Swamy is funded by a studentship between the University of Nottingham and SurePulse Medical Ltd. Simon Stockwell is funded via the EPSRC and an associated PhD CASE award from SurePulse Medical Ltd. The following are University of Nottingham employees and/or shareholders in SurePulse Medical Ltd—Don Sharkey, Barrie Hayes-Gill, John Crowe (Emeritus Professor) and Steve Morgan. Don Sharkey and Barrie Hayes-Gill are non-executive directors of SurePulse Medical Ltd.; : This study was approved by NHS Health Research Authority 15/YH/0522, HeartLight study Clinicaltrials.gov NCT02701920, 3/3/2016 and subsequently by MHRA. This trial followed ISO14155 GCP which was in accordance with the guidelines of the World Medical Association’s Declaration of Helsinki. A written informed parental consent was obtained for the publication of the details of the medical cases and any accompanying images or videos prior to infant enrolment.