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Resuscitation. 2017 Aug;117:80-86. doi: 10.1016/j.resuscitation.2017.06.007. Epub 2017 Jun 9.

The relation between given volume and heart rate during newborn resuscitation.

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Department of Pediatrics, Stavanger University Hospital, Norway. Electronic address:
Department of Research, Stavanger University Hospital, Stavanger, Norway; Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway.
Department of Pediatrics, Division of Newborn Medicine, Weill Cornell Medical College, 525 East 68th Street, New York, NY, USA.
Department of Pediatrics, Stavanger University Hospital, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway.
Department of Clinical Research, Haydom Lutheran Hospital Mbulu, Tanzania.
Ministry of Health, Dar Es Salaam, Tanzania.
Department of Anesthesiology and Intensive Care, Stavanger University Hospital, POB 8100, 4068, Stavanger, Norway; Department of Health Science, University of Stavanger, Stavanger Norway. Electronic address:



During delivery room resuscitation of depressed newborns, provision of appropriate tidal volume (TV) with establishment of functional residual capacity (FRC) is essential for circulatory recovery. Effective positive pressure ventilation (PPV) is associated with a rapid increase in heart rate (HR). The relationship between delivery of TV and HR responses remains unclear.


The study objectives were to determine (1) the relationship between a given TV during initial PPV and HR responses of depressed newborns, and (2) the optimal delivered TV associated with a rapid increase in HR.


In a Tanzanian rural hospital, ventilation and ECG signals were recorded during neonatal resuscitation and stored in Neonatal Resuscitation Monitors. Resuscitators without positive end-expiratory pressure were used for PPV. No oxygen was used. Perinatal events were observed and recorded by research assistants.


215 newborns of gestational age 37.3±1.9 weeks and birth weight 3115±579g were included. There was a non-linear relationship between delivered TV and HR increase. TV of 9.3ml/kg produced the largest increase in HR during PPV. Frequent interruptions of PPV sequences to provide stimulation/suctioning occurred in all cases and were associated with further HR increases, especially for newborns with initial HR<100 beats/minute.


There was a consistent positive relationship between HR increase and delivered TV. The unanticipated finding of a further increase in HR with PPV pauses to provide stimulation/suctioning suggests that most newborns were in primary rather than secondary apnea.


Heart rate response; Neonatal resuscitation; Positive pressure ventilation; Resuscitation monitor; Tidal volume

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