RT Journal Article SR Electronic T1 Cardiac arrest with pulseless electrical activity rhythm in newborn infants: a case series JF Archives of Disease in Childhood - Fetal and Neonatal Edition JO Arch Dis Child Fetal Neonatal Ed FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health SP F572 OP F574 DO 10.1136/archdischild-2018-316087 VO 104 IS 6 A1 Deandra Luong A1 Po-Yin Cheung A1 Keith J Barrington A1 Peter G Davis A1 Jennifer Unrau A1 Shyamala Dakshinamurti A1 Georg M Schmölzer YR 2019 UL http://fn.bmj.com/content/104/6/F572.abstract AB The 2015 neonatal resuscitation guidelines added ECG to assess an infant’s heart rate when determining the need for resuscitation at birth. However, a recent case report raised concerns about this technique in the delivery room. We report four cases of pulseless electrical activity during neonatal cardiopulmonary resuscitation in levels II–III neonatal intensive care units in Canada (Edmonton [n=3] and Winnipeg [n=1]).Healthcare providers should be aware that pulseless electrical activity can occur in newborn infants during cardiopulmonary resuscitation. We propose an adapted neonatal resuscitation algorithm to include pulseless electrical activity. Furthermore, in compromised newborns, heart rate should be assessed using a combination of methods/techniques to ensure accurate heart rate assessment. When ECG displays a heart rate but the infant is unresponsive, pulseless electrical activity should be suspected and chest compression should be started.