title: Pedi-cap color change precedes a significant increase in heart rate during neonatal resuscitation.
abstract: BACKGROUND
  Heart rate is the most important indicator of infant well-being during neonatal resuscitation. The Nellcor Pedi-Cap turns gold when exposed to exhaled gas with CO₂>15 mmHg. The aim of this study was to determine if Pedi-Cap gold color change during neonatal resuscitation precedes an increase in heart rate in babies with bradycardia receiving mask ventilation.
  
  
  METHODS
  This was a single-center retrospective review of video recordings and physiologic data of newborns with bradycardia receiving mask positive pressure ventilation during neonatal resuscitation. Subjects were included if the baby's HR<100 BPM within the first 90 s of resuscitation. The primary outcome was the change in HR prior to Pedi-Cap gold color change compared to the HR after Pedi-Cap gold color change.
  
  
  RESULTS
  Forty-one newborns during the study period had HR<100 BPM and received mask positive pressure ventilation with a Pedi-Cap. The median heart rate 10s prior to Pedi-Cap gold color change was 75 BPM (IQR 62-85) and increased to 136 BPM (IQR 113-158) 30 s after gold color change (p<0.001). SpO₂ increased from 45 ± 17% prior to Pedi-Cap gold color change to 52 ± 17% 30s after gold color change (p=0.001).
  
  
  CONCLUSIONS
  Colorimetric CO₂ detection during mask positive pressure ventilation in neonatal resuscitation precedes a significant increase in heart rate and SpO₂. The Pedi-Cap can be easily applied during resuscitation, requires no electricity, provides immediate feedback and may be a useful, simple tool early in resuscitation and may be especially useful in resource limited settings.
authors.affiliation: Division of Neonatology, UCSD Medical Center, University of California, San Diego, CA, USA. Electronic address: blankdouglas@gmail.com.
authors.forename: Doug
authors.initials: D
authors.lastname: Blank
authors.affiliation: Division of Neonatology, UCSD Medical Center, University of California, San Diego, CA, USA.
authors.forename: Wade
authors.initials: W
authors.lastname: Rich
authors.affiliation: Division of Neonatology, Columbia University, New York, NY, USA.
authors.forename: Tina
authors.initials: T
authors.lastname: Leone
authors.affiliation: Division of Neonatology, UCSD Medical Center, University of California, San Diego, CA, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Garey
authors.affiliation: Division of Neonatology, UCSD Medical Center, University of California, San Diego, CA, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Finer
mesh_terms: D001919:Bradycardia / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D019296:Capnography / Q000295:instrumentation* / Q000379:methods; D002245:Carbon Dioxide / Q000032:analysis*; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation* / Q000379:methods; D015331:Cohort Studies; D003116:Color; D015897:Comorbidity; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000379:methods; D011175:Positive-Pressure Respiration / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013610:Tachycardia / Q000175:diagnosis* / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D002245:Carbon Dioxide
keywords: Electrocardiogram; End tidal carbon dioxide; Heart rate; Pedi-Cap; Positive pressure ventilation; Saturation of peripheral oxygen