Delivery room desaturations and bradycardia in the early postnatal period of healthy term neonates – a prospective observational study

Abstract

Objective

It has been suggested that desaturations and bradycardia precede acute life-threatening events (ALTE) and that ALTE is more common in the delivery room than later in life. However, frequency, duration and severity of desaturations in the first hours of life and additional risk factors have not readily been studied.

Methods

Term neonates (n = 100) were monitored for the first two hours after birth by pulse oximetry. The impact of maternal and perinatal factors on the frequency and severity of desaturations (<85%) and bradycardia (<80/min) was evaluated.

Results

Desaturations were detected in 30%, prolonged desaturations in 25% of infants. Desaturations were observed significantly more often in infants born by planned Cesarean section (pCs) compared to other modes of delivery (pCs 20/49; others 10/51; p = .029). Desaturations were also more frequent in infants diagnosed with neonatal infection (NI) or infants born to a mother with gestational diabetes (GDM), although not significantly. No bradycardia <80/min was detected.

Conclusions

In our collective 4% of healthy term neonates had prolonged, clinically relevant desaturations in the first hours after birth. The mode of delivery and maternal risk factors may increase the risk for these events. However, our cohort was too small to detect any ALTE or SIDS and determine potential risk factors for these events. Our data lay ground for a large-scale prospective trial to investigate whether the mode of delivery could be an indication for general pulse oximetry monitoring of newborn in the delivery room.

Keywords:

• Postnatal SpO₂
• heart rate
• delivery room ALTE
• term newborn
• bradycardia

Acknowledgements

We thank the midwives and medical staff of our Perinatal Center for their support in conducting this study. We would also like to thank all the parents who allowed us to take measurements on their newborns.

Ethical approval

The study was approved by the local ethics committee of Ludwig-Maximilian-University (LMU) Munich/Germany (protocol number: 320/11).

Author contributions

M. Burgmann conceived and designed the work that led to the submission, acquired data, and played an important role in interpreting the results. She drafted the manuscript and approved the final version.

K. Foerster conceived the work that led to the submission, acquired data, and played an important role in interpreting the results. He revised the manuscript and approved the final version.

M. Klemme conceived the work that led to the submission, acquired data, and played an important role in interpreting the results. He revised the manuscript and approved the final version.

M. Delius conceived the work that led to the submission, acquired data, analyzed data for both manual and automated analysis, and played an important role in interpreting the results. She revised the manuscript and approved the final version.

C. Huebener conceived the work that led to the submission, acquired data, and played an important role in interpreting the results. He revised the manuscript and approved the final version.

R. Wißkott programed the automatic algorithm for the detection of desaturations.

A. L. Boulesteix conceived and designed the work that led to the submission, analyzed data for both manual and automated analysis, and played an important role in interpreting the results. She drafted and revised the manuscript and approved the final version.

A. W. Flemmer conceived and designed the work that led to the submission, acquired data, and played an important role in interpreting the results. He drafted and revised the manuscript and approved the final version.

Disclosure statement

No potential conflict of interest was reported by the author(s).