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Original research
Improving newborn heart rate assessment using a simple visual timer
  1. Caroline Henry1,
  2. David E Morris2,
  3. Sophie Coleman1,
  4. Andrea Pereira1,
  5. Christian Tamakloe3,
  6. Peter Blanchfield4,
  7. Don Sharkey5
  1. 1Division of Child Health, Obstetrics and Gynaecology, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
  2. 2Faculty of Engineering, University of Nottingham, Nottingham, UK
  3. 3School of Computer Science, University of Nottingham, Nottingham, UK
  4. 4I-Bit Software, Nottingham, UK
  5. 5Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
  1. Correspondence to Dr Don Sharkey; don.sharkey{at}


Objective Newborn resuscitation relies on accurate heart rate (HR) assessment, which, during auscultation, is prone to error. We investigated if a 6 s visual timer (VT) could improve HR assessment accuracy during newborn simulation.

Design Prospective observational study of newborn healthcare professionals.

Setting Three-phase developmental approach: phase I: HR auscultation during newborn simulation using a standard clock timer (CT) or the VT; phase II: repeat phase I after using a bespoke training app (NeoRate); phase III: following the Newborn Life Support course, participants assessed random HRs using the CT or VT.

Main outcome measures HR accuracy (within ±10 beats/min, correct HR category, i.e. <60, 60–100 and >100 beats/min), assessment time and error-free rates were compared.

Results Overall, 1974 HR assessments were performed with participants more accurate using the VT for ±10 beats/min (70% CT vs 86% VT, p<0.001) and correct HR category (78% CT vs 84% VT, p<0.01). The VT improved accuracy across all three phases. Additionally, following app training in phase II, the HR accuracy of both the CT and VT improved. The VT resulted in faster HR assessment times of 11 s (IQR 9–13) compared with the CT at 15 s (IQR 9–23, p<0.001). Error-free scenarios increased from 24% using the CT to 57% using the VT (p<0.001), with a shorter assessment time (CT 116 s (IQR 65–156) vs VT 53 s (IQR 50–64), p<0.001).

Conclusion Using a VT to assess simulated newborn HR combined with a training app significantly improves accuracy and reduces assessment time compared with standard methods. Evaluation in the clinical setting is required to determine potential benefits.

  • neonatology
  • resuscitation
  • measurement

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  • Contributors We confirm that all authors have made substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of the data for the work; drafting the work or revising it critically for important intellectual content; approval of the version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This work was supported by Chiesi Foundation, Parma (no grant number, personal to CH) and the University of Nottingham Hermes Funding (no grant number, internal to DS).

  • Competing interests DS is a non-executive director and shareholder in SurePulse Medical Ltd, which is developing new vital sign monitoring methods for newborn babies.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval for this study was given by the University of Nottingham, School of Medicine Ethics Committee (F10072014 SoM CH), and by the Resuscitation Council UK for phase III.

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

  • Data availability statement Data are available upon reasonable request. All data available upon request from Dr Don Sharkey (

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