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Impact of a mobile application for heart rate assessment in simulated neonatal resuscitation: a randomised controlled cross-over study
  1. Francesco Cavallin1,
  2. Marco Binotti2,
  3. Pierluigi L Ingrassia3,
  4. Giulia Genoni4,
  5. Stefano Rizzollo4,
  6. Alice Monzani4,
  7. Daniele Trevisanuto5
  1. 1 Independent Statistician, Solagna, Italy
  2. 2 Division of Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria ’Maggiore della Carità', Novara, Italy
  3. 3 Centro Interdipartimentale di Didattica Innovativa e di Simulazione in Medicina e Professioni Sanitarie (SIMNOVA), University of Piemonte Orientale, Novara, Italy
  4. 4 Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
  5. 5 Dipartimento di Salute della Donna e del Bambino, Universita degli Studi di Padova, Padova, Italy
  1. Correspondence to Dr Daniele Trevisanuto, Department of Woman’s and Child’s Health, University of Padova, 35122 Padova, Italy; daniele.trevisanuto{at}


Background Clinical assessment of newborn heart rate (HR) at birth has been reported to be inaccurate. NeoTapAdvancedSupport (NeoTapAS) is a free-of-charge mobile application that showed good accuracy in HR estimation. This study aimed to evaluate the impact of NeoTapAS on timing of HR communication and resuscitation interventions.

Methods This was a randomised controlled cross-over (AB/BA) study evaluating HR assessment using auscultation plus NeoTapAS compared with auscultation plus mental computation in a high-fidelity simulated newborn resuscitation scenario. Twenty teams each including three paediatric residents were randomly assigned to AB or BA arms. The primary outcome was the timing of the first HR communication. Secondary outcomes included the timing of the following four HR communications and the timing of resuscitation interventions (positive pressure ventilation, chest compressions, intubation and administration of first dose of epinephrine).

Results NeoTapAS reduced the time to the first HR communication (mean difference −13 s, 95% CI −23 to −4; p=0.009), and the time of initiation of chest compressions (mean difference −68 s, 95% CI −116 to −18; p=0.01) and administration of epinephrine (mean difference −76 s, 95% CI −115 to −37; p=0.0004) compared with mental computation.

Conclusions In a neonatal resuscitation simulated scenario, NeoTapAS reduced the time to the first HR communication and the time of initiation of chest compressions and administration of epinephrine compared with mental computation. This app can be especially useful in settings with limited availability of monitoring equipment, but further studies in clinical scenarios are warranted.

Trial registration number NCT03730025.

  • NeoTapAS
  • mobile application
  • neonatal resuscitation
  • heart rate
  • timing

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  • Contributors FC and DT carried out the analyses and drafted the work. MB, PLI, GG, SR and AM designed the work, acquired the data and reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The Ethics Committee of ‘Maggiore della Carità’ Hospital (Novara, Italy) deemed that a formal ethical approval was not required since the study used manikin data (Prot 759/CE).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.