{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T07:16:47Z","timestamp":1792653407085,"version":"4.5.0"},"reference-count":5,"publisher":"BMJ","issue":"2","funder":[{"DOI":"10.13039\/100004411","name":"Heart and Stroke Foundation of Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004411","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Arch Dis Child Fetal Neonatal Ed"],"accepted":{"date-parts":[[2018,5,24]]},"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The 2015 neonatal resuscitation guidelines added ECG as a recommended method of assessment of an infant\u2019s heart rate (HR) when determining the need for resuscitation at birth. However, a recent case report raised concerns about this technique in the delivery room.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To compare accuracy of ECG with auscultation to assess asystole in asphyxiated piglets.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Neonatal piglets had the right common carotid artery exposed and enclosed with a real-time ultrasonic flow probe and HR was continuously measured and recorded using ECG. This set-up allowed simultaneous monitoring of HR via ECG and carotid blood flow (CBF). The piglets were exposed to 30\u2009min normocapnic alveolar hypoxia followed by asphyxia until asystole, achieved by disconnecting the ventilator and clamping the endotracheal tube. Asystole was defined as zero carotid blood flow and was compared with ECG traces and auscultation for heart sounds using a neonatal\/infant stethoscope.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Overall, 54 piglets were studied with a median (IQR) duration of asphyxia of 325 (200-491) s. In 14 (26%) piglets, CBF, ECG and auscultation identified asystole. In 23 (43%) piglets, we observed no CBF and no audible heart sounds, while ECG displayed an HR ranging from 15 to 80\/min. Sixteen (30%) piglets remained bradycardic (defined as HR of &lt;100\/min) after 10\u2009min of asphyxia, identified by CBF, ECG and auscultation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Clinicians should be aware of the potential inaccuracy of ECG assessment during asphyxia in newborn infants and should rather rely on assessment using a combination of auscultation, palpation, pulse oximetry and ECG.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/archdischild-2018-314907","type":"journal-article","created":{"date-parts":[[2018,6,12]],"date-time":"2018-06-12T12:16:12Z","timestamp":1528805772000},"page":"F215-F217","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":30,"title":["Pulseless electrical activity: a misdiagnosed entity during asphyxia in newborn infants?"],"prefix":"10.1136","volume":"104","author":[{"given":"Sparsh","family":"Patel","sequence":"first","affiliation":[{"name":"Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada"},{"name":"Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Po-Yin","family":"Cheung","sequence":"additional","affiliation":[{"name":"Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada"},{"name":"Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne Lee","family":"Solev\u00e5g","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada"},{"name":"Department of Pediatric and Adolescent Medicine, Akershus University Hospital, L\u00f8renskog, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith J","family":"Barrington","sequence":"additional","affiliation":[{"name":"Centre-Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C Omar Farouk","family":"Kamlin","sequence":"additional","affiliation":[{"name":"Newborn Research Centre, The Royal Women\u2019s Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter G","family":"Davis","sequence":"additional","affiliation":[{"name":"Newborn Research Centre, The Royal Women\u2019s Hospital, Melbourne, Victoria, Australia"},{"name":"Neonatal Research, Murdoch Children\u2019s Research Institute, Melbourne, Victoria, Australia"},{"name":"Department of Obstetrics and Gynaecology, University Of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9798-2415","authenticated-orcid":false,"given":"Georg M","family":"Schm\u00f6lzer","sequence":"additional","affiliation":[{"name":"Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada"},{"name":"Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,6,12]]},"reference":[{"key":"2025090511494761000_104.2.F215.1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000267"},{"key":"2025090511494761000_104.2.F215.2","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1159\/000441940","article-title":"Heart rate assessment immediately after birth","volume":"109","author":"Phillipos","year":"2016","journal-title":"Neonatology"},{"key":"2025090511494761000_104.2.F215.3","doi-asserted-by":"crossref","first-page":"F88.1","DOI":"10.1136\/archdischild-2017-313928","article-title":"ECG monitoring in the delivery room is not reliable for all patients","volume":"103","author":"Hodgson","year":"2018","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"2025090511494761000_104.2.F215.4","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.002289"},{"key":"2025090511494761000_104.2.F215.5","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000275"}],"container-title":["Archives of Disease in Childhood - Fetal and Neonatal Edition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/archdischild-2018-314907","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T19:03:20Z","timestamp":1757099000000},"score":1,"resource":{"primary":{"URL":"https:\/\/fn.bmj.com\/lookup\/doi\/10.1136\/archdischild-2018-314907"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6,12]]},"references-count":5,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2019,2,19]]},"published-print":{"date-parts":[[2019,3]]}},"alternative-id":["10.1136\/archdischild-2018-314907"],"URL":"https:\/\/doi.org\/10.1136\/archdischild-2018-314907","relation":{},"ISSN":["1359-2998","1468-2052"],"issn-type":[{"value":"1359-2998","type":"print"},{"value":"1468-2052","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6,12]]}}}