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Cited by 7Non-Invasive Vital Sign MonitoringHemodynamic Monitoring and TherapyHeart Rate Variability and Autonomic Control

Comparing peripheral limb and forehead vital sign monitoring in newborn infants at birth

Open access
Swamy, Suvvi K. Narayana, Stockwell, Simon J., Liu, Chong, Henry, Caroline, Shipley, Lara, Ward, Carole, Mirahmadi, Siavash, Correia, Ricardo +4 more·2026·Pediatric Research
DOI 10.1038/s41390-024-03651-0PMC PMC12956579
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Abstract

Background: To study the feasibility of measuring heart rate (HR) and oxygen saturation (SpO 2 ) on the forehead, during newborn transition at birth, and to compare these measurements with those obtained from the wrist. Methods: Vital signs were measured and compared between forehead-mounted reflectance (remittance) photoplethysmography sensor (fhPPG) and a wrist-mounted pulse oximeter sensor (wrPO), from 20 enrolled term newborns born via elective caesarean section, during the first 10 min of life. Results: From the datasets available ( n = 13), the median (IQR) sensor placement times for fhPPG, ECG and wrPO were 129 (70) s, 143 (68) s, and 159 (76) s, respectively, with data recorded for up to 10 min after birth. The success rate (percentage of total possible HR values reported once sited) of fhPPG (median = 100%) was higher compared to wrPO (median = 69%) during the first 6 min of life ( P < 0.005). Both devices exhibited good HR agreement with ECG, achieving >95% agreement by 3 (fhPPG) and 4 (wrPO) min. SpO 2 for fhPPG correlated with wrPO ( r = 0.88), but there were significant differences in SpO 2 between the two devices between 3 and 8 min ( P < 0.005), with less variance observed with fhPPG SpO 2 . Conclusion: In the period of newborn transition at birth in healthy term infants, forehead measurement of vital signs was feasible and exhibited greater HR accuracy and higher estimated SpO 2 values compared to wrist-sited pulse oximetry. Further investigation of forehead monitoring based on the potential benefits over peripheral monitoring is warranted. Impact: This study demonstrates the feasibility of continuously monitoring heart rate and oxygen saturation from an infant’s forehead in the delivery room immediately after birth. Significantly higher SpO 2 measurements were observed from the forehead than the wrist during the transition from foetal to newborn life. Continuous monitoring of vital signs from the forehead could become a valuable tool to improve the delivery of optimal care provided for newborns at birth.

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  • For infants who experience hypothermia or low body temperatures, distal measurement locations like the hand and foot often face limited perfusion to protect vital organs.

    “In addition, for infants who experience hypothermia or low body temperatures, which is common for infants in the Ethiopian NICU, distal measurement locations like the hand and foot often face limited perfusion to protect vital organs8–11.”

    From Soft, all-in-one, nanomembrane wearable system for advancing neonatal health monitoring in Ethiopia (2025) · cites this paper as [11]

    The Introduction says peripheral monitoring in newborns can be affected by poor tissue perfusion, and the Discussion says fingers, toes and wrists are prone to vasoconstriction and low perfusion. The paper does not establish that this occurs specifically in hypothermic infants to protect vital organs, or that hypothermia is common in Ethiopian NICUs; its newborn study involved healthy term infants at birth. (LLM, conf=0.85)

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Research works printed but not linked: 1

  1. [18]Chen, W., Ayoola, I., Oetomo, S. B. & Feijs, L. In 2010 Design, Automation & Test in Europe Conference & Exhibition (DATE 2010) 1530–1535 (Institute of Electrical and Electronic Engineers, 2010).

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Authors
Swamy, S. K. N., Stockwell, S. J., Liu, C., Henry, C., Shipley, L., Ward, C., Mirahmadi, S., Correia, R., Morgan, S. P., Crowe, J. A., Sharkey, D., & Hayes-Gill, B. R.
Affiliations
University of Nottingham (GB)
ORCID
Venue
Pediatric Research
Publisher
Springer Science and Business Media LLC
Published
2024-10-17
Volume
99
Issue
2
Pages
598-603
ISSN
  • 0031-3998 (ISSN-L)
  • 1530-0447
DOI
10.1038/s41390-024-03651-0
PMC
PMC12956579
OpenAlex
W4403510694
Cited by
7
References
38
Citations by year
2026: 2 · 2025: 5
FWCI
0.77
Type
journal article
Language
en
Open access
Licence
Locations
  • Pediatric Research (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Repository@Nottingham (University of Nottingham) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
Funders
  • UK Research and Innovation
  • University of Nottingham (EP/R511730/1)
  • Medical Research Council (MC_PC_15012)
  • Engineering and Physical Sciences Research Council (EP/R513283/1, EP/K503101/1, EP/T517902/1, EP/R511730/1)
Topics
  • Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
  • Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Keywords
pulse oximetry, heart rate monitoring, oxygen saturation, transition at birth, term infants, sensor placement, non-invasive monitoring, delivery room care
MeSH terms
Oxygen Saturation, Electrocardiography, Feasibility Studies, Female, Forehead, Heart Rate, Humans, Infant, Newborn, Male, Monitoring, Physiologic, Oximetry, Wrist, Photoplethysmography, Vital Signs

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