Heart rate (HR)

Measurement of the HR (at the umbilical cord, by auscultation, by pulse oximetry or ECG) is the most objective indicator of: (1) the newborn's clinical condition, (2) the need for PPV (HR <100 bpm) or chest compressions (HR <60 bpm), and (3) a good response to one's resuscitation efforts (e.g., rise in HR after successful mask-PPV or endotracheal intubation plus PPV). The HR should correlate with the pulse palpated (brachial or femoral artery).

Pulse oximetry (SpO2, HR)

An analysis of six studies aimed at estimating the “normal SpO2 in newborn infants in the first minutes of life” revealed that in term and near-term infants a (pre- or postductal) SpO2 of 90% was reached at about 5 minutes of life. The SpO2 at 1 min of life ranged from 40% to 70%. SpO2 was generally lower in preterm infants and in those delivered by cesarean section. Postductal SpO2 (feet) was 7–10 percentage points lower than preductal SpO2 30.

Heart rate and SpO2 tracings are more easily picked up when the transducer is placed at the hands rather than the feet (perfusion more often impaired in the feet). If the neonate shows no early signs of dyspnea (nasal flaring, retractions at about 5–15 min postnatally) and no longer needs supplemental oxygen, then the baby should be wrapped up warmly and laid on the mother's chest (if necessary, monitored with a pulse oximeter). The 10-min Apgar score and a 30-min postnatal blood glucose and blood gas analysis can be obtained thereafter.