Original article
Neonatal bradycardia following nasopharyngeal stimulation

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Suctioning of the nasopharynx immediately after birth is a widely used procedure in normal and abnormal neonates; it may result in cardiac arrhythmias of vagal origin. Instantaneously recorded neonatal heart rates and electrocardiograms were obtained from one minute to one hour of life in 87 neonates who also were monitored in utero during labor. After delivery, 41 infants received repeated nasopharyngeal suction with a bulb syringe; no decreases in heart rate were noted. The other 46 neonates were suctioned with a nasogastric tube attached to a glass de Lee trap. The nasogastric tube was blindly intoduced through the nose or the mouth. Following suction, 7 infants in the latter group developed severe cardiac arrhythmias, and 5 of them also became apneic. These undesirable responses are of enough concern to warrant re-examination of such widely accepted clinical procedures and to stimulate additional studies in this area.

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Supported in part by Research Grants HD 01467-03 and 5K03 and HD18, 259-06 from the National Institute of Child Health and Human Development and carried out in the Yale University Perinatal Research Center (USPH-125-06).

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Present address: Department of Obstetrics andGynecology, University of Southern California Medical Center, 1200 N. State St., Los Angeles, Calif. 90033.

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