Any views please on whether ecg monitoring is preferable to pulse oximetry alone in neonates? Practice is varied in UK but unable to find supporting evidence.

Our choice of monitoring "level" depends on the degree of illness of the infant (which is far from rocket-science )

All infants considered instable or at risk of instability (such as newly admitted babies with suspected infection, breathing problems needing nCPAP, born after very preterm delivery etc) are monitored with ECG and pulse oximetry. As pulse oximetry can fail due to poor signal etc, one can be sure to see brady/tachycardias with ECG monitoring. I personally also like to see the breathing pattern in babies I "don't know well", and that parameter is recorded from the equipment we use.

However, I often feel that we keep the ECG electrodes too long and that one should be able to use only pulse oximetry sooner than we do today (in the units where I work).

Exception - the most immature infants (23w'ers) are sometimes only monitored by pulse oximetry as their skin can be so thin and electrodes are so sticky...

Thanks, Stefan.

We are presently merging 2 large units into one neonatal "supercentre" and are reviewing guidelines for just about everything. However the more basic procedures are the most difficult to agree on! One unit uses ecg leads routinely on every baby whilst the other only uses them for cardiac/deranged electrolytes etc. I think ideally we should move away from "routine" but we still need guidelines for clinical governance and for guidance for the huge influx of inexperienced staff to refer to.

I do agree with your point about extreme preterm babies.