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Cardiorespiratory monitoring in the delivery room using transcutaneous electromyography
  1. Ruud W van Leuteren1,2,
  2. Eline Kho1,3,
  3. Cornelia G de Waal1,
  4. Arjan B te Pas4,
  5. Hylke H Salverda4,
  6. Frans H de Jongh1,5,
  7. Anton H van Kaam1,6,
  8. Gerard J Hutten1,6
  1. 1 Department of Neonatology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, North-Holland, Netherlands
  2. 2 Amsterdam Reproduction & Development Research Institute, Amsterdam, North-Holland, Netherlands
  3. 3 Technical Medicine, University of Twente, Enschede, Overijssel, Netherlands
  4. 4 Department of Neonatology, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
  5. 5 Faculty of Science and Technology, University of Twente, Enschede, Overijssel, Netherlands
  6. 6 Department of Neonatology, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, North-Holland, Netherlands
  1. Correspondence to Ruud W van Leuteren, Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands; r.w.vanleuteren{at}


Objective To assess feasibility of transcutaneous electromyography of the diaphragm (dEMG) as a monitoring tool for vital signs and diaphragm activity in the delivery room (DR).

Design Prospective observational study.

Setting Delivery room.

Patients Newborn infants requiring respiratory stabilisation after birth.

Interventions In addition to pulse oximetry (PO) and ECG, dEMG was measured with skin electrodes for 30 min after birth.

Outcome measures We assessed signal quality of dEMG and ECG recording, agreement between heart rate (HR) measured by dEMG and ECG or PO, time between sensor application and first HR read-out and agreement between respiratory rate (RR) measured with dEMG and ECG, compared with airway flow. Furthermore, we analysed peak, tonic and amplitude diaphragmatic activity from the dEMG-based respiratory waveform.

Results Thirty-three infants (gestational age: 31.7±2.8 weeks, birth weight: 1525±661 g) were included.

18%±14% and 22%±21% of dEMG and ECG data showed poor quality, respectively. Monitoring HR with dEMG was fast (median 10 (IQR 10–11) s) and accurate (intraclass correlation coefficient (ICC) 0.92 and 0.82 compared with ECG and PO, respectively). RR monitoring with dEMG showed moderate (ICC 0.49) and ECG low (ICC 0.25) agreement with airway flow. Diaphragm activity started high with a decreasing trend in the first 15 min and subsequent stabilisation.

Conclusion Monitoring vital signs with dEMG in the DR is feasible and fast. Diaphragm activity can be detected and described with dEMG, making dEMG promising for future DR studies.

  • neonatology
  • physiology
  • resuscitation

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  • Contributors RWvL, CGdW, FHdJ, GJH and AHvK made substantial contributions to the conception and design of the study. RWvL, EK and HS included infants in the study. RWvL and EK analysed the data. RWvL wrote the first version of the manuscript. All authors are acknowledged for their critical revision of the manuscript. All authors approved submission of the paper for publication

  • 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.

  • Patient consent for publication Not required.

  • Ethics approval The institutional review boards of the Amsterdam UMC in Amsterdam and the Leiden University Medical Centre in Leiden (METC AMC, ABR registration, NL64266.018.18).

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

  • Data availability statement Limited data are available on reasonable request. Unpublished data of the measurements in this cohort are only accessible to the authors of the paper. It is saved in a locked database.