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Changes in heart rate in the first minutes after birth
  1. JA Dawson1,2,3,
  2. COF Kamlin1,2,3,
  3. C Wong1,
  4. AB te Pas4,
  5. M Vento5,
  6. TJ Cole6,
  7. SM Donath3,
  8. SB Hooper7,
  9. PG Davis1,2,3,
  10. CJ Morley1,2,3
  1. 1Neonatal Services, The Royal Women's Hospital, Melbourne, Australia
  2. 2Department of Paediatrics, Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Australia
  3. 3Murdoch Children's Research Institute, Melbourne, Australia
  4. 4Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
  5. 5Neonatal Research Unit, Division of Neonatology Hospital La Fe, Valencia, Spain
  6. 6MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK
  7. 7Department of Physiology, Monash University, Victoria, Australia
  1. Correspondence to Ms Jennifer A Dawson, Neonatal Services, Newborn Research, 7th floor, The Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria, 3052, Australia; jennifer.dawson{at}


The normal range of heart rate (HR) in the first minutes after birth has not been defined.

Objective To describe the HR changes of healthy newborn infants in the delivery room (DR) detected by pulse oximetry.

Study Design All inborn infants were eligible and included if a member of the research team attended the birth. Infants were excluded if they received any form of medical intervention in the DR including supplemental oxygen, or respiratory support.

HR was measured using a pulse oximeter (PO) with the sensor applied to the right hand or wrist immediately after birth. PO data (oxygen saturation, HR and signal quality) were downloaded every 2 sec and analysed only when the signal had no alarm messages (low IQ signal, low perfusion, sensor off, ambient light).

Results Data from 468 infants with 61 650 data points were included. Infants had a mean (range) gestational age of 38 (25–42) weeks and birth weight 2970 (625–5135) g. At 1 min the median (IQR) HR was 96 (65–127) beats per min (bpm) rising at 2 min and 5 min to 139 (110–166) bpm and 163 (146–175) bpm respectively. In preterm infants, the HR rose more slowly than term infants.

Conclusions The median HR was <100 bpm at 1 min after birth. After 2 min it was uncommon to have a HR <100 bpm. In preterm infants and those born by caesarean section the HR rose more slowly than term vaginal births.

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  • Funding JAD, COFK and ATB are past recipients of a RWH Postgraduate Scholarship. ATP is recipient of a Ter Meulen Fund grant for working visits, Royal Netherlands Academy of Arts and Sciences, The Netherlands. PGD is a recipient of an NHMRC Practitioner Fellowship. PGD, SBH and CJM hold an Australian National Health and Medical Research Council Program Grant No. 384100. TJC received funding from the UKMRC.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Study endorsed by The Royal Women's Hospital Research Committee.

    Detail has been removed from these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

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