Oxygen saturation after birth in resuscitated neonates in Uganda: a video-based observational study

Abstract

Background: Monitoring of peripheral capillary oxygen saturation (SpO₂) during neonatal resuscitation is standard of care in high-resource settings, but seldom performed in low-resource settings. We aimed to measure SpO₂ and heart rate during the first 10 min of life in neonates receiving positive pressure ventilation (PPV) according to the Helping Babies Breathe (HBB) protocol and compare results with SpO₂ and heart rate targets set by the American Heart Association (AHA).

Methods: A cross-sectional study was conducted at Mulago National Referral Hospital, Kampala, Uganda, as a substudy of the NeoSupra Trial. SpO₂ and heart rate were measured on apnoeic neonates (≥34 weeks) who received PPV according to HBB (room air). Those who remained distressed after PPV received supplemental oxygen (O₂). All resuscitations were video recorded and data were extracted by video review at 1 min intervals until 10 min post partum. Data were analysed for all observations and separately for only observations before and during PPV.

Results: 49 neonates were analysed. Median SpO₂ at 5 min (n=39) was 67% (49-88) with 59% of the observations below AHA target of 80%. At 10 min median SpO₂ (n=44) was 93% (80-97) and 32% were below AHA target of 85%. When only observations before and during PPV were analysed, median SpO₂ at 5 min (n=18) was 52% (34-66) and 83% were below AHA target. At 10 min (n=15), median SpO₂ was 72% (57-89) and 67% were below AHA target. Median heart rates were above AHA target of 100 beats/min at all time intervals.

Conclusions: A high proportion of neonates resuscitated with PPV after birth failed to reach the AHA SpO₂ target in this small sample, implying an increased risk of hypoxic-ischaemic encephalopathy. Further studies in low-resource settings are needed to evaluate baseline data and the need for supplemental O₂ and optimal SpO₂ during PPV.

Trial registration number: This is a substudy to the trial 'Neonatal Resuscitation with Supraglottic Airway Trial (NeoSupra)'; ClinicalTrials.gov Registry (NCT03133572).

Keywords: neonatology; physiology; resuscitation.