Our Research
The Tap4Life team does research on our products to assess the quality and the feasibility. We publish our results in peer-reviewed academic journals.
Accurate and fast neonatal heart rate assessment with a smartphone-based application – A manikin study
Aim: This study determined the accuracy and speed of the NeoTapLifeSupport (NeoTapLS), a free smartphone application that aims to assess a neonate’s heart rate.
Methods: We asked 30 participants with a variety of backgrounds to test the NeoTapLS, which was developed by our own nonprofit organisation Tap4Life, to determine a randomly selected heart rate by auscultation or palpation. The study was carried out in 2014 at Sachs’ Children and Youth Hospital, Sweden, using a Laerdal SimNewB manikin that simulates true values. The NeoTapLS calculates the heart rate based on the user’s last three taps on the smartphone screen.
Results: A total of 1200 measurements were carried out. A high correlation was found between measured and true values by auscultation (correlation coefficient 0.993) as well as by palpation (correlation coefficient 0.986) with 93.5% of the auscultations and 86.3% of the palpations differing from the true value by five beats or fewer. The mean time to the first estimated heart rate was 14.9 seconds for auscultation and 16.3 seconds for palpation.
Conclusion: Heart rates could be accurately and rapidly assessed using the NeoTapLS on a manikin. A globally accessible mobile health system could offer a low-cost alternative to expensive medical equipment.
Myrnerts Hook S, Pejovic NJ, Marrone G, Tylleskar T, Alfven T. Accurate and fast neonatal heart rate assessment with a smartphone-based application – A manikin study.doi: 10.1111/apa.14350. Acta Paediatr 2018..
Smartphone app for neonatal heart rate assessment – an observational study
Background Heart rate (HR) assessment is crucial in neonatal resuscitation, but pulse oximetry (PO) and electrocardiography (ECG) are rarely accessible in low-resource to middle-resource settings. This study evaluated a free-of-charge smartphone application, NeoTap, which records HR with a screen-tapping method bypassing mental arithmetic calculations.
Methods This observational study was carried out during three time periods between May 2015 and January 2019 in Uganda in three phases. In phase 1, a metronome rate (n=180) was recorded by low-end users (midwives) using NeoTap. In phase 2, HR (n=69) in breathing neonates was recorded by high-end users (paediatricians) using NeoTap versus PO. In phase 3, HR (n=235) in non-breathing neonates was recorded by low-end users using NeoTap versus ECG.
Results In high-end users the mean difference was 3 beats per minute (bpm) higher with NeoTap versus PO (95% agreement limits −14 to 19 bpm), with acquisition time of 5 seconds. In low-end users, the mean difference was 6 bpm lower with NeoTap versus metronome (95% agreement limits −26 to 14 bpm) and 3 bpm higher with NeoTap versus ECG in non-breathing neonates (95% agreement limits −48 to 53 bpm), with acquisition time of 2.7 seconds. The agreement between NeoTap and ECG was good in the HR categories of 60–99 bpm and ≥100 bpm; HR <60 bpm had few measurements (kappa index 0.71, 95% CI 0.63 to 0.79).
Conclusion HR could be accurately and rapidly assessed using a smartphone application in breathing neonates in a low-resource setting. Clinical assessment by low-end users was less accurate with wider CI but still adds clinically important information in non-breathing neonates. The authors suggest low-end users may benefit from auscultation-focused training. More research is needed to evaluate its feasibility in clinical use.
Myrnerts Hook S, Pejovic NJ, Cavallin F, Lubulwa C, Byamugisha J, Nankunda J, Tylleskär T, Alfvén T. Smartphone app for neonatal heart rate assessment– an observational study. Doi:10.1136/bmjpo-2020-000688. BMJ Paediatrics Open 2020.
Neonatal Supraglottic Device Trial – NeoSupra Trial
In december 2015 our team received a research grant FRIMEDBIO from the Research Council of Norway to conduct a phase II study on ventilation in neonatal resuscitation in low-resource settings. As part of the trial NeoTapAS and NeoTapLS is used. The trial was conducted at Mulago National Referral Hospital, Kampala, Uganda. The recruitments started 8th of May 2018 and ended the 12th of August 2019, a total of 1163 resuscitation was recruited and all were video filmed. Two members of the Tap4Life team, Dr Susanna Myrnerts Höök and Dr Nicolas Pejovic, have on and off been living in Uganda to run the trial giving the Tap4Life team excellent insight in the challenging work at a referral hospital in a low-resource setting. “Neonatal Resuscitation with Supraglottic Airway Trial” (NeoSupra), ClinicalTrials.gov NCT03133572.
Pejovic NJ*, Myrnerts Höök S*, Byamugisha J, Alfvén T, Lubulwa C, Cavallin F, Nankunda J, Ersdal E, Blennow M, Trevisanuto D, Tylleskär T. A randomized trial of laryngeal mask airway in neonatal resuscitation. The New England Journal of Medicine 2020;383:2138-47. Doi:10.1056/NEJMoa2005333.
*contributed equally to this article.
Pejovic NJ, Myrnerts Höök S, Byamugisha J, Trevisanuto D, et al. Neonatal resuscitation using a supraglottic airway device for improved mortality and morbidity outcomes in a low-income country: study protocol for a randomized trial. doi: 10.1186/s13063-019-3455-8. Trials. 2019 Jul 19;20(1):444.
Prior to the NeoSupra trial we conducted a manikin study and a phase II trial involving NeoTap:
Pejovic NJ, Trevisanuto D, Nankunda J, Tylleskär T. Pilot manikin study showed that a supraglottic airway device improved simulated neonatal ventilation in a low-resource setting. doi: 10.1111/apa.13565 Acta Paediatr. 2016 Dec;105(12):1440-1443.
Pejovic NJ, Trevisanuto D, Lubulwa C, et al. Neonatal resuscitation using a laryngeal mask airway: a randomised trial in Uganda. Arch Dis Child. 2017. DOI:10.1136/archdischild-2017-312934
Research on NeoTap
Three other teams have also evaluated NeoTap.
Evaluation of a Tap-Based Smartphone App for Heart Rate Assessment During Asphyxia in a Porcine Model of Neonatal Resuscitation.
Johnson PA, Morina N, O’Reilly M, Lee TF, Cheung PY, Schmölzer GM. Evaluation of a Tap-Based Smartphone App for Heart Rate Assessment During Asphyxia in a Porcine Model of Neonatal Resuscitation. Front Pediatr. 2019 Nov 5;7:453. doi: 10.3389/fped.2019.00453.
Novel technologies for heart rate assessment during neonatal resuscitation at birth – A systematic review
Johnson PA, Morina N, Cheung PY, Lee TF, O´Reilly, Schmölzer GM. Novel technologies for heart rate assessment during neonatal resuscitation at birth – A systematic review. doi: 10.1016/j.resuscitation.2019.07.018. Resuscitation. 2019 Oct;143:196-207.
Impact of a mobile application for heart rate assessment in simulated neonatal resuscitation: a randomised controlled cross-over study
Cavallin F, Binotti M, Ingrassia PL, et al. Impact of a mobile application for heart rate assessment in simulated neonatal resuscitation: a randomised controlled cross-over study.doi: 10.1136/archdischild-2018-316757 Arch Dis Child Fetal Neonatal Ed. 2019.
Heart rate assessment using NeoTapAdvancedSupport: a simulation study
Binotti M, Cavallin F, Ingrassia PL, et al. Heart rate assessment using NeoTapAdvancedSupport: a simulation study. doi: 10.1136/archdischild-2018-315408 Arch Dis Child Fetal Neonatal Ed. 2018.
Other Research
Heart Rate Assessment Immediately after Birth
Phillipos E, Solevag AL, Pichler G, et al. Heart Rate Assessment Immediately after Birth. Neonatology. 2016;109(2):130-138.
A systematic review of novel technology for monitoring infant and newborn heart rate
Kevat AC, Bullen DV, Davis PG, Kamlin CO. A systematic review of novel technology for monitoring infant and newborn heart rate. Acta Paediatr. 2017;106(5):710-720.
Response to resuscitation of the newborn: early prognostic variables
Saugstad, O.D., et al., Response to resuscitation of the newborn: early prognostic variables. Acta Paediatr, 2005. 94(7): p. 890-5.
A randomised, simulated study assessing auscultation of heart rate at birth
Voogdt, K.G., et al., A randomised, simulated study assessing auscultation of heart rate at birth. Resuscitation, 2010. 81(8): p. 1000-3.
Accuracy of clinical assessment of infant heart rate in the delivery room
Kamlin, C.O., et al., Accuracy of clinical assessment of infant heart rate in the delivery room. Resuscitation, 2006. 71(3): p. 319-21.
Determination of heart rate in the baby at birth
Owen, C.J. and J.P. Wyllie, Determination of heart rate in the baby at birth. Resuscitation, 2004. 60(2): p. 213-7.
Cardiorespiratory Monitoring during Neonatal Resuscitation for Direct Feedback and Audit
van Vonderen JJ, van Zanten HA, Schilleman K, et al. Cardiorespiratory Monitoring during Neonatal Resuscitation for Direct Feedback and Audit. Front Pediatr. 2016;4:38.
Part 5: Neonatal Resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Aziz K, Lee HC, Escobedo MB, Hoover AV, Kamath-Rayne BD, Kapadia VS, Magid DJ, Niermeyer S, Schmölzer GM, Szyld E, Weiner GM, Wyckoff MH, Yamada NK, Zaichkin J. Part 5: Neonatal Resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020 Oct 20;142(16_suppl_2):S524-S550. doi: 10.1161/CIR.0000000000000902. Epub 2020 Oct 21. PMID: 33081528.
Part 7: Neonatal resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations
Wyllie J, Perlman JM, Kattwinkel J, et al. Part 7: Neonatal resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation. 2015;95:e169-201.
Assessment of neonatal resuscitation skills: A reliable and valid scoring system
Philine A. van der Heidea,b, Letty van Toledo-Eppinga, Maaike van der Heide, Johanna H. van der Lee. Assessment of neonatal resuscitation skills: A reliable and valid scoring system. Resuscitation (2006) 71, 212—221)
Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis
Munabi-Babigumira S, Glenton C, Lewin S, Fretheim A, Nabudere H. Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis. Cochrane Database Syst Rev. 2017;11:CD011558.
Evaluation of Heart Rate Assessment Timing, Communication, Accuracy, and Clinical Decision-Making during High Fidelity Simulation of Neonatal Resuscitation
Boon W, McAllister J, Attar MA, Chapman RL, Mullan PB, Haftel HM. Evaluation of Heart Rate Assessment Timing, Communication, Accuracy, and Clinical Decision-Making during High Fidelity Simulation of Neonatal Resuscitation. Int J Pediatr. 2014;2014:927430.
The accuracy of human senses in the detection of neonatal heart rate during standardized simulated resuscitation: implications for delivery of care, training and technology design
Chitkara R, Rajani AK, Oehlert JW, Lee HC, Epi MS, Halamek LP. The accuracy of human senses in the detection of neonatal heart rate during standardized simulated resuscitation: implications for delivery of care, training and technology design. Resuscitation. 2013;84(3):369-372.
Auscultate, palpate and tap: time to re-evaluate
Hawkes GA, Hawkes CP, Kenosi M, et al. Auscultate, palpate and tap: time to re-evaluate. Acta Paediatr. 2016;105(2):178-182.
Helping babies breathe around the world
Steele C. Helping babies breathe around the world. J Obstet Gynecol Neonatal Nurs. 2013;42(2):243-246.
Accuracy of clinical assessment of infant heart rate in the delivery room
Kamlin CO, O’Donnell CP, Everest NJ, Davis PG, Morley CJ. Accuracy of clinical assessment of infant heart rate in the delivery room. Resuscitation. 2006;71(3):319-321.
Comparison of infant heart rate assessment by auscultation, ECG and oximetry in the delivery room
Murphy MC, De Angelis L, McCarthy LK, O’Donnell CPF. Comparison of infant heart rate assessment by auscultation, ECG and oximetry in the delivery room. Arch Dis Child Fetal Neonatal Ed. 2018;103(5):F490-F492.
Normal Newborn Heart Rate in the First Five Minutes of Life Assessed by Dry-Electrode Electrocardiography
Linde JE, Schulz J, Perlman JM, et al. Normal Newborn Heart Rate in the First Five Minutes of Life Assessed by Dry-Electrode Electrocardiography. Neonatology. 2016;110(3):231-237.
Conferences
Abstracts have been presented at many conferences both in Europe, Africa and the United States.
Smartphone app for neonatal heart rate assessment – an observational study
Oral presentation by Dr Susanna Myrnerts Höök
NeoTap LS- Life Support- a new free-of-charge mHealth tool to support neonatal resuscitation.
MedInfo 2019 PAS (Pediatric Academic Societies) in Baltimore, USA
Poster
Johnson PA MN, Cheung PY, Lee TF, O´Reilly, Schmölzer GM. Comparison of the digital Stethoscope and NeoTapLS smartphone app to assess heart rate during asphyxia in a swine model of neonatal resuscitation. PAS 2019; 2019; Baltimore, USA.