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

BACKGROUND: Monitoring of peripheral capillary oxygen saturation (SpO(2)) during neonatal resuscitation is standard of care in high-resource settings, but seldom performed in low-resource settings. We aimed to measure SpO(2) 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 SpO(2) 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. SpO(2) 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 (O(2)). 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 SpO(2) at 5 min (n=39) was 67% (49–88) with 59% of the observations below AHA target of 80%. At 10 min median SpO(2) (n=44) was 93% (80–97) and 32% were below AHA target of 85%. When only observations before and during PPV were analysed, median SpO(2) at 5 min (n=18) was 52% (34–66) and 83% were below AHA target. At 10 min (n=15), median SpO(2) 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 SpO(2) 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 O(2) and optimal SpO(2) during PPV. TRIAL REGISTRATION NUMBER: This is a substudy to the trial ‘Neonatal Resuscitation with Supraglottic Airway Trial (NeoSupra)’; ClinicalTrials.gov Registry (NCT03133572).