Limited agreement between clinical assessment of infant colour at birth and oxygen saturation in a hospital in Ethiopia.

AIM: To evaluate the relationship between clinical assessment of infant colour and oxygen saturation at birth in a low-resource setting. METHODS: Classification of infant colour (cyanotic, pink or unclear) by midwives was compared to pulse-oximeter data at 60-90-120-300 seconds after birth in 60 neonates. RESULTS: Overall, oxygen saturation increased over time (P < .0001) and was different according to infant colour (P < .0001). Median oxygen saturation in pink infants was 87% at 60 seconds (n = 1), 90% (IQR 83-91) at 90 seconds (n = 5), 86% (IQR 81-94) at 120 seconds (n = 11) and 93% (IQR 90-96) at 300 seconds (n = 20). Median oxygen saturation in cyanotic infants was 60% (IQR 45-70) at 60 seconds (n = 52), 64% (IQR 52-69) at 90 seconds (n = 42), 63% (IQR 56-68) at 120 seconds (n = 35) and 66% (IQR 62-74) at 300 seconds (n = 22). Median oxygen saturation in unclear-coloured infants was 57% (IQR 56-60) at 60 seconds (n = 7), 78% (IQR 71-81) at 90 seconds (n = 13), 81% (IQR 79-88) at 120 seconds (n = 14) and 80% (IQR 76-84) at 300 seconds (n = 18). The proportion of infants with unclear colour ranged from 12% to 30%. CONCLUSION: The variability of oxygen saturation among pink and cyanotic infants, and the substantial proportion of unclear infant colour, suggest the possible benefit of the availability of pulse oximetry in low-resource settings.

Heart Rate Determination in Newborns at Risk for Resuscitation in a Low-Resource Setting: A Randomized Controlled Trial.

OBJECTIVE: To compare 2 different methods (auscultation with a stethoscope and umbilical cord palpation) of heart rate (HR) estimation in newborns at risk for resuscitation in a low-resource setting. STUDY DESIGN: Sixty newborns at risk for resuscitation born at the St. Luke Catholic Hospital in Wolisso (Ethiopia) were randomized to HR assessment by auscultation using a stethoscope or umbilical cord palpation. HR was assessed at 60, 90, 120 seconds, and 5 minutes of life. The primary outcome was the agreement of HR obtained by auscultation or palpation compared with the HR determined by electrocardiogram. RESULTS: Mean difference between auscultation using a stethoscope and electrocardiogram was -13 bpm, -4 bpm, -6 bpm, and -10 bpm at 60, 90, 120 seconds, and at 5 minutes of life. Mean difference between palpation and electrocardiogram of was -20 bpm, -25 bpm, -23 bpm, and -31 bpm at 60, 90, 120 seconds, and at 5 minutes of life. The magnitude of the difference between auscultation and electrocardiogram was lower than that between palpation and electrocardiogram over time (P = .007). HR range was correctly identified in 14 out of 16 measurements (87%) with HR <100 bpm. CONCLUSION: HR assessment by auscultation was more accurate compared with cord palpation, but both may provide adequate clinical information to healthcare providers in terms of HR ranges. The clinical advantage of providing a stethoscope in low-resource settings remains to be established. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03854435.