Logan Reid
Hospital newborn monitors are used to measure vital signs such as heart rate, blood pressure, and oxygen levels. They are usually equipped with sensors that detect electrical signals produced by the heart and send data to a monitor. These sensors may be patches that stick to the skin or small clips on the finger or toe. While hospital-grade monitors are considered safe and accurate, consumer-grade baby monitors have been found to have concerns with accuracy and may lead to false positive alarms. It is important to consult a doctor or a medical professional for advice on the usage and interpretation of newborn monitors.
| Characteristics | Values |
|---|---|
| Heart rate | Usually shown as beats per minute (bpm); normal range for adults is 60-100bpm |
| Blood pressure | Displayed with two numbers: systolic (top number) and diastolic (bottom number); normal is around 120/80 mmHg |
| Body temperature | Normal range for adults is 97.8-99°F (36.6-37.2°C); over 99°F (37°C) is a fever |
| Oxygen saturation (SpO2) levels | Normal range is 95%-100%; below 90% is considered low (hypoxemia) |
| Respiratory rate | Standard rate for adults is 12-16 breaths per minute at rest |
| Electrocardiogram (ECG) | Records the electrical activity of the heart; used to indicate respiratory rate or breathing patterns |
| Alarm | Sounds a warning if vital signs rise or fall outside healthy levels |
| Colors | Used to help healthcare providers quickly identify essential information; red signals critical values |
| Sensors | Small sensors attached to the body carry information to the monitor; some are patches that stick to the skin, others may be clipped to a finger |
| Fetal heart rate monitoring | Measures the heart rate and rhythm of a baby (fetus); average rate is 110-160bpm |
| Electronic fetal monitoring (EFM) | More advanced and accurate than fetal heart rate monitoring; monitors both fetal heart rate and mother's contractions |
| EFM tracings | Can be complicated and subjective to interpret; uniform guidelines have been developed to standardise interpretation |
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Heart rate
The heart rate of a newborn is a critical indicator of their health and well-being. Fetal heart rate monitoring is a common procedure used to measure the heart rate and rhythm of a developing fetus during pregnancy, labour, and delivery. Healthcare providers may use this method to assess the health of the fetus and detect any potential problems.
Methods of Heart Rate Monitoring
There are several methods for monitoring a newborn's heart rate:
- Doppler Ultrasound: This method uses sound waves to measure the fetal heart rate. A handheld Doppler device is placed on the mother's abdomen, and the heartbeat is displayed on a screen. This is often used during prenatal visits and can be purchased for at-home use, although the FDA does not recommend it due to risks such as inaccurate results and lack of control over usage.
- Continuous Electronic Monitoring: During labour and delivery, healthcare providers may opt for continuous monitoring. An ultrasound device is held in place on the mother's abdomen with an elastic strap, and a second strap measures contractions. Wires from the instruments attach to a monitor, providing a continuous readout of the fetal heart rate.
- Internal Monitoring: A thin wire or electrode is inserted through the cervix and attached to the baby's scalp. This method provides more accurate readings as it is not affected by movement but can only be used if the amniotic sac has broken and the cervix is open.
- Manual Auscultation and Palpation: These methods are considered less reliable and antiquated compared to other techniques. Auscultation is done at the apical site, while palpation can be performed at the brachial, femoral, or umbilical site in newborns.
Normal Fetal Heart Rate
The average fetal heart rate is between 110 and 160 beats per minute, with fluctuations of 5 to 25 beats per minute considered normal. Deviations from this range or excessive fluctuations may indicate that the fetus is not receiving enough oxygen or that there are other health concerns.
Neonatal heart rate monitoring is crucial during high-risk deliveries and resuscitation attempts. It helps assess the effectiveness of chest compressions, ventilation, and airway clearance. The use of a neonatal heart rate monitor, such as an ECG, is recommended for rapid and accurate heart rate measurements during resuscitation.
Interpreting Heart Rate Readings
When monitoring a newborn's heart rate, healthcare providers will look for stable readings within the normal range. Deviations from the normal range or irregular patterns may prompt further testing or emergency interventions. Continuous monitoring allows for the detection of trends in heart rate patterns, helping healthcare providers make informed decisions about the care of the newborn.
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Blood pressure
Proper blood pressure measurement is critical in newborns, who naturally have lower blood pressure. Attention to blood pressure cuff size, location, and method of measurement are all essential. The use of intra-arterial catheters for long-term blood pressure monitoring in newborns is decreasing, so further studies are needed to validate and develop oscillometric methodology with enhanced accuracy.
Some interventions during acute newborn care, such as umbilical catheterization and the use of steroids, can result in elevated blood pressure. Therefore, accurate monitoring for possible hypertension is essential during their recovery.
Healthcare providers will also look for any signs of illness or birth defects when examining a newborn's blood pressure.
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Body temperature
There are several methods for measuring a newborn's body temperature, each with its advantages and disadvantages. The ideal method should be simple, rapid, non-invasive, reproducible, cost-effective, and accurately reflect the newborn's core body temperature.
One common method is to use a digital thermometer, which is recommended by doctors as it provides the quickest and most accurate readings. These thermometers can be used to measure rectal, oral (under the tongue), or axillary (armpit) temperatures. When taking a rectal temperature, it is important to use a digital rectal thermometer with a short probe to reduce the risk of injury. Armpit temperature readings are slightly lower than oral readings as they measure the temperature outside the body. It is recommended to always use the armpit method for children under 5 years old.
Another method is the ear (tympanic) thermometer, which is quick but can be expensive and challenging to use correctly, especially in newborns with small ear holes. Forehead (temporal artery) thermometers are also an option, providing an accurate and non-invasive way to measure core body temperature through the artery on the forehead. However, sunlight and cold temperatures can affect the readings.
It is important to avoid taking a newborn's temperature right after a bath or if they were under blankets or swaddled, as these factors can influence the reading. Additionally, it is recommended to wait 5 minutes after the newborn has had a hot or cold drink before taking their temperature.
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Oxygen levels
Pulse oximetry is a non-invasive, needlestick-free, and radiation-free type of measurement testing. It is a simple and painless test that measures how much oxygen is in the blood. The device measures oxygen saturation as a percentage and scores the number out of 100. A pulse oximeter will typically read this number as SpO2%. In a healthy infant, normal SpO2 is around 95–100%. SpO2 below 90% is a clear indicator of hypoxemia that requires supplemental oxygen. SpO2 should be kept above this 90% marker at all times for young children.
Pulse oximetry can be performed as part of an arterial blood gas test, where a respiratory therapist will take a sample of blood from one of your arteries. For newborns, this sample may be taken from the baby's heel or umbilical cord.
It is important to note that commercially available baby monitors have shown concerning results in measuring vital signs, including oxygen levels. These products are not regulated by the U.S. Food & Drug Administration (FDA). Therefore, it is recommended to use medical-grade devices for accurate measurements.
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Respiratory rate
For adults, the normal resting respiratory rate typically ranges from 12 to 20 breaths per minute. However, it's important to note that normal respiratory rates can vary depending on factors such as age, activity level, BMI, sex, and overall health. For example, the normal respiratory rate for a baby can range from 110 to 160 breaths per minute, which is significantly higher than that of an adult.
In a hospital setting, respiratory rate is monitored continuously, especially in neonatal intensive care units (NICUs) for preterm infants. This continuous monitoring is crucial as it provides indicators of health conditions and can help predict clinical deterioration and mortality. Additionally, respiratory rate waveforms provide valuable insights into lung function and overall respiratory health. A healthy waveform should display a consistent and smooth pattern. Deviations from this pattern may indicate respiratory issues such as tachypnea, apnea, or dyspnea.
Oxygen saturation levels are also monitored to track respiratory health and intervene if oxygen levels drop below the normal range. This is especially important for patients with respiratory conditions or those recovering from surgery or critical illness. By understanding oxygen saturation levels, healthcare providers can ensure the body receives the necessary oxygen supply and provide timely interventions when needed.
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Frequently asked questions
Hospital newborn monitors display vital signs such as heart rate, blood pressure, body temperature, and oxygen levels.
If there is an issue with the baby's vital signs, the monitor will usually sound a warning, such as a beeping noise or a flashing colour. If there is a warning, carefully check the readings and follow any instructions provided by medical staff.
The normal range for oxygen saturation (SpO2) is usually between 95% and 100%. If the oxygen saturation falls below 90%, it is considered low, and doctors may provide extra oxygen or other treatments.
