. Amnioinfusion for umbilical cord compression in the presence of decelerations reduced: fetal heart rate decelerations (NNT = 3); cesarean delivery overall (NNT = 8); Apgar score < 7 at five minutes (NNT = 33); low cord arterial pH (< 7.20; NNT = 8); neonatal hospital stay > three days (NNT = 5); and maternal hospital stay > three days (NNT = 7). This web game uses NICHD terminology to identify tracing elements and categorize EFM tracings. However, it can take some practice to hear the heartbeat using this method, especially if the baby is moving around. It's typically the first time they hear their babys heartbeat during a prenatal visit. Are there decelerations present? Buttocks. Avoid fetal "keepsake" images, heartbeat monitors. However, you don't need to worry about this right now especially if you prepare well with the help of our amazing quiz! This web game uses NICHD terminology to identify tracing elements and categorize EFM tracings. A prenatal non-stress test (NST) can be used to assess fetal heart rate and movement at around 26 to 28 weeks of gestation. By Brandi Jones, MSN-ED RN-BC What qualifies as a rapid fetal heart rate? Healthcare providers may also use continuous external electronic monitoring during labor. May 2, 2022 The NCC EFM Tracing Game is part of the free online EFM toolkit at NCC-EFM.org. repositioning, stopping oxytocin, assessment of hypotension) fails to improve the tracing, deliver rapidly and safely Category II This web game uses NICHD terminology to identify tracing elements and categorize EFM tracings. Acceleration All rights reserved. Impact of maternal exercise during pregnancy on offspring chronic disease susceptibility. Postpartum Hemorrhage MCQ Quiz Questions And Answers, Ectopic pregnancy quiz questions and answers. Fetal heart tracing allows your doctor to measure the rate and rhythm of your little one's heartbeat. Powered by Powered by Effects of prenatal stress on pregnancy and human development: Mechanisms and pathways. -recurrent late decel w moderate baseline variability We strive for 100% accuracy, but nursing procedures and state laws are constantly changing. All Rights Reserved. Electronic fetal monitoring is used to record the heartbeat of the fetus and the contractions of the mother's uterus before and during labor. Second-stage fetal heart rate abnormalities and type of neonatal acidemia. Intrapartum fetal heart rate monitoring. The periodic review includes ensuring that a good quality tracing is present and that abnormalities are appropriately communicated. STEM Entrance Exam Quiz: Can you pass this Stem Exam? Bulk pricing was not found for item. Fetal heart rate (FHR) may change as they respond to different conditions in your uterus. A baseline of less than 110 bpm is defined as bradycardia.11 Mild bradycardia (100 to 110 bpm) is associated with post-term infants and occipitoposterior position.15 Rates of less than 100 bpm may be seen in fetuses with congenital heart disease or myocardial conduction defects.15 A baseline greater than 160 bpm is defined as tachycardia11 (Online Figure B). Fetal Tracing Quiz 1. . -often *correctable by changes in maternal position to relieve pressure* on cord -marked baseline variability, absence of induced accels after fetal stimulation, Periodic or episodic decels in category II, -recurrent variable decels w minimal-moderate baseline variability -*associated w decreased or absent FHR variability*, 110-160 bpm Fetal pulse oximetry has not shown a reduction in cesarean delivery rates. Brandi is a nurse and the owner of Brandi Jones LLC. Itis called fetal tachycardia when it is greater than 180 BPM. ", "The Second Look files are phenomenal and were an excellent way to test my knowledge after I had studied a bit.". -prolonged decel >2 min but <10 min At 12 h after incubation, the cells on the . In 1822, a French obstetrician gave the first written detailed description of fetal heart sounds. The baseline when the woman's abdomen is relaxed will be from zero to 10. Check out a suggested systematic approach from the AAFP below! Understanding the physiology of fetal oxygenation and various influences on fetal heart rate control supports nurses, midwives, and physicians in interpreting and managing electronic fetal heart rate tracings during labor and birth. FHR tracing, nonstress test, and ultrasound Teen pregnancy and consent issues: mother has consent over anything related to her pregnancy but anything apart . Healthcare providers usually start listening for a babys heart rate at the 10- or 12-week prenatal visit. https://www.mayoclinic.org/tests-procedures/nonstress-test/about/pac-20384577 In addition, you must know what is causing each type of deceleration, such as uteroplacental insufficiency or umbilical cord compression. You scored 6 out of 6 correct. In addition, she explains how to identify each decelerations which makes learning this material very easy to remember. This content is owned by the AAFP. doi:10.1136/hrt.2005.069369. Your doctor will explain the steps of the procedure. This measurement helps healthcare providers determine the well-being of the fetus during prenatal visits or labor. A. Read our. 2016;123(6):870-870. doi:10.1111/1471-0528.13844. Electronic fetal monitoring may help detect changes in normal FHR patterns during labor. -up to 4 hours Although continuous EFM remains the preferred method for fetal monitoring, the following methodologies are active areas of research in enhancing continuous EFM or developing newer methodologies for fetal well-being during labor. This depends on the source and duration of your increased heart rate. Baseline Rate (BRA; Online Table B). CVS: 8-12 weeks, checks genetic/biochemical abnormalities, and short waiting time. They do a great job of both teaching and quizzing you on the relevant material. During a term antepartum NST (non-stress test), you notice several variable decelerations that decrease at least 15 bpm and last at least 15 secs long. ____ Prolonged D.)Gradual decrease; nadir If any problems arise, reviews are done more frequently. Obstetrician-Gynecologist, Medical Consultant, https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/fetal-heart-monitoring A wooden artifact is found in an ancient tomb. Braxton Hicks vs. Real Contractions: How to Tell the Difference? For simplicity, assume that the tags are separated by spaces, and V. Fetal heart rate patterns in the second stage of labor. Here's what University of Michigan Medical Students said about the SecondLookTM concept: "The Second Look (files) have been a godsend. Abrupt decrease, > 15 bpm, Decrease in FHR is 15 bpm or greater, lasting 15 seconds, and < 2 minutes in duration. Marked. While EFM use may be common and widespread, there is controversy about its efficacy, interobserver and intraobserver variability, and management algorithms. Fetal Heart Rate Monitoring - Freeman 2012 "Fetal heart rate monitoring is widely used by almost every obstetrician as a way to document the case and to help decrease health care costs. The inner tags must be closed before the outer ones. Professionals using Electronic Fetal Monitoring in their practice should also take advantage of: The EFM Resources page with linked papers and articles including the NCC monograph Fetal Assessment and Safe Labor Management authored by Kathleen Rice Simpson, PhD, RNC-OB, CNS-BC, FAAN. Subtle, shallow late decelerations can be difficult to visualize, but can be detected by holding a straight edge along the baseline. The resulting printout is known as a fetal heart tracing, which will be read and analyzed. Compared with structured intermittent auscultation, a period of EFM on maternity unit admission results in a lack of improved neonatal outcomes and increased interventions, including epidural analgesia (NNH = 19), continuous EFM (NNH = 7), and fetal blood scalp testing (NNH = 45). 30 min-2hrs For example, if there is a drop in FHR, and then 30 seconds later it rises again, this is more likely a deceleration than a fetal bradycardia. Tracing patterns can and will change! file containing tags. Exerc Sport Sci Rev. If the baby is experiencing fetal bradycardia, that means it isn't getting . -variable decels w no other characteristics, -*absent baseline variability and any of following*: contraction Management depends on the clinical picture and presence of other FHR characteristics.18, Overall Assessment (O). The fetal heart rate and contraction information appear on an attached computer screen. -*occur in presence of normal FHR variability* Remember, the baseline is the average heart rate rounded to the nearest five bpm.140 145 150 155 160 FHT Quiz 1 Fetal Tracing Quiz Perfect! A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Contractions (C). Accelerations last from 15 seconds to 10 minutes, and the majority occur in conjunction with fetal movements. is part of the free online EFM toolkit at. Intraobserver variability may play a major role in its interpretation. Coussons-Read ME. Together with Flo, learn how fetal heart tracing actually works. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Accelerations (A). ET). Study with Quizlet and memorize flashcards containing terms like What is the most common OB procedure done?, What is the goal fo fetal monitoring?, What is the downside to fetal heart monitoring? International Journal of Gynecology & Obstetrics. --> decreased intervillous exchange of oxygen adn CO2 and progressive fetal hypoxia and acidemia, *abrupt, onset <30 sec* visually apparent decreases in FHR below baseline FHR These settings will apply for this game only and take precedence over Global Settings that are set on the Customize page. The 2008 National Institute of Child Health and Human Development Workshop Report on Electronic Fetal . Am I Having Depression During Pregnancy? Specific FHR tracings are analyzed in a stepwise manner. This mobile app covers the following topics: Basics of reading and evaluating fetal heart rate tracings, including baseline determination and variability; the evaluation and biological background of various types of accelerations and decelerations; and a set with case examples for practicing the interpretation of FHR tracings. Prior . Your doctor can confirm the likelihood of hypoxic injury using fetal heart tracing. Perineal massage: What you need to know before giving it a go. -pressure on fetal head Abrupt increases in the FHR are associated with fetal movement or stimulation and are indicative of fetal well-being11 (Online Table B, Online Figure G). Reviewed by Eugenia Tikhonovich, MD Obstetrician-Gynecologist, Medical Consultant This system can be used in conjunction with the Advanced Life Support in Obstetrics course mnemonic, DR C BRAVADO, to assist in the systematic interpretation of fetal monitoring. The information is reviewed in a stepwise fashion to guide the learner through the evaluation of this commonly-used diagnostic procedure and discusses different clinical scenarios and their impact on patient care. Fetal Heart Tracing Quiz 1 - FHT Quiz 1 Fetal Tracing Quiz. . -*sinusoidal pattern*. Espinoza A, Lee W, Belfort M, Shamshirsaz A, Mastrobattista J, Espinoza J. Fetal tachycardia is an independent risk factor for chromosomal anomalies in firsttrimester genetic screening. If the heart rate is out of the normal range, the team can do an ultrasound or order blood work. Ayres-de-Campos D, Spong C, Chandraharan E. FIGO consensus guidelines on intrapartum fetal monitoring: Cardiotocography. What is the baseline of the FHT? If you have any feedback on our "Countdown to Intern Year" series, please reach out to Samhita Nelamangala at d4medstudrep@gmail.com. This is done to ensure that the baby is healthy and growing normally. What Does Deceleration During Labor Mean? Occasional use of Dopplers by a healthcare provider is considered safe. Conversely, hearing a fetal heart rate by home Doppler in certain situations may provide a false sense of security when medical attention is actually needed. Compare maternal pulse simultaneously with FHR, According to AWHONN, the normal baseline Fetal Heart Rate (FHR) is. meconium stained amniotic fluid is present in 10-20% of births, and most neonates don't experience issues. Decrease in FHR from the baseline that is 15 bpm or more, lasting 2 minutes or more but less than 10 minutes in duration. < 32 weeks EGA: peak 10 bpm above baseline, duration 10 seconds but < 2 minutes from onset of the acceleration to return to baseline. Prolonged decelerations (Online Figures K and L) last longer than two minutes, but less than 10 minutes.11 They may be caused by a number of factors, including head compression (rapid fetal descent), cord compression, or uteroplacental insufficiency. Accelerations represent a sudden increase in FHR of more than 15 bpm in bandwidth amplitude. Obstet Gynecol 1987; 70:191. 32 weeks EGA: peak 15 bpm above baseline, duration 15 seconds but < 2 minutes from onset of the acceleration to return to baseline. This is a short reference on the physiologic benefits, instrumentation, application and interpretation of fetalheart rate monitoring. The NCC EFM Tracing Game uses NICHD terminology. Tracings of the normal fetal heart rate are between 120 and 160. BASIC Fetal Heart Monitoring This workshop was developed for the RN with 0-6 months experience in L&D. The course will define methods of monitoring, instrumentation, physiology and pathophysiology of the FHR, FHR characteristics, as well as review common antenatal testing methods. Are there accelerations present? Electronic fetal monitoring is performed in a hospital or doctors office. Contractions are classified as normal (no more than five contractions in a 10-minute period) or tachysystole (more than five contractions in a 10-minute period, averaged over a 30-minute window).11 Tachysystole is qualified by the presence or absence of decelerations, and it applies to spontaneous and stimulated labor. We have other quizzes matching your interest. Write a program that checks whether a sequence of HTML tags is properly nested. ____ Variable C.)> 15 bpm below basline for U.S. Food and Drug Administration. However, extensive use at home could lead to unanticipated negative consequences. These segments help establish an estimated baseline (for a duration of 10 minutes) which is expressed in beats per minute. FETAL HEART TRACING. Your program should process a . Your doctor can then take steps to manage the underlying medical problem. Additionally, you may have difficulty detecting the heart rate even when the baby is perfectly fine. Periodic changes in FHR, as they relate to uterine contractions, are decelerations that are classified as recurrent if they occur with 50 percent or more of contractions in a 20-minute period, and intermittent if they occur with less than 50 percent of contractions.11 The decrease in FHR is calculated from the onset to the nadir of the deceleration. Variability describes fluctuations in the baseline FHR, whether in terms of frequency, amplitude, or magnitude. You can check out all our previous content here if you didnt get a chance to see it. -use has decreased a lot (probably not used at UM), -made of: amniotic fluid, lanugo (fine hair covering fetus), bile, fetal skin/ intestinal cells What to Know About Epilepsy and Pregnancy. --recurrent late decels A way to assess your babys overall health, fetal heart tracing is performed before and during the process of labor. MedlinePlus. They continue to monitor it during prenatal appointments and during labor. However, prolonged anxiety, stress, and high blood pressure could negatively affect your babys health. 4. The FHR normally exhibits variability, with an average change of 6 to 25 bpm of the baseline rate, and is linked to the fetal central nervous system. She specializes in health and wellness writing including blogs, articles, and education. Umbilical cord influences that can alter blood flow include true knots, hematomas, and the number of umbilical vessels. Once I complete the Second Look, I know I'm ready to quiz. What interventions would you take after evaluating this strip and why? Print Worksheet. A normal baseline rate ranges from 110 to 160 bpm. (2007). Q: What is the most common obstetric procedure in the United States? Matching Practice basic fetal tracing analysis with some quizzes: Quizzes 1-5 Quizzes 6-10 Combine your ability to read fetal tracings with clinical management with some cases: Cases 1-5 If you want to see how you are doing overall, try the comprehensive assessment: -early labor: 0-6cm, 6-12 hours Baseline rate: 110 to 160 bpm . A normal fetal heart rate is 110 - 160 beats per minute. Create engaging Jeopardy-style quiz games in minutes or choose from millions of existing Jeopardy game templates. NCC EFM Tracing Game. A change in baseline FHR is said to occur when the change persists for 10 minutes or longer. Risk increases with factors such as: A fetal heart rate gives you and your healthcare team information about your babys health during pregnancy. Continuous monitoring of your babys heart rate is conducted during labor and delivery as well. Other times, it indicates a health concern for the baby. Fetal heart rate monitoring may be performed exter-nally or internally. Questions and Answers 1. View questions only 3/10/2017 Fetal Heart Tracing Quiz 1 Correct. Scroll down for another when you're done. duration https://www.acog.org/~/media/For%20Patients/faq015.pdf. Fetal Heart Tracing Quiz 1 FHT Quiz 1 Fetal Tracing Quiz Please answer each question. A meta-analysis showed that if there is absent or minimal variability without spontaneous accelerations, the presence of an acceleration after scalp stimulation or fetal acoustic stimulation indicates that the fetal pH is at least 7.20.19, If the FHR tracing remains abnormal, these tests may need to be performed periodically, and consideration of emergent cesarean or operative vaginal delivery is usually recommended.15 Measurements of cord blood gases are generally recommended after any delivery for abnormal FHR tracing because evidence of metabolic acidosis (cord pH less than 7.00 or base deficit greater than 12 mmol per L) is one of the four essential criteria for determining an acute intrapartum hypoxic event sufficient to cause cerebral palsy.20, When using continuous EFM, tracings should be reviewed by physicians and labor and delivery nurses on a regular basis during labor. Late decelerations (Online Figure J) are visually apparent, usually symmetric, and have the characteristic feature of onset of the deceleration after the onset of the uterine contraction.11 The timing of the deceleration is delayed, with the nadir of the deceleration occurring after the peak of the contraction.11 The onset, nadir, and recovery of the deceleration usually occur after the beginning, peak, and ending of the contraction, respectively. For more information on the use, interpretation and management of patients based on Fetal Heart Tracings check out the resources below. Obstet Med. Hornberger, L. K., & Sahn, D. J. American Pregnancy Association. In 2013, researchers proposed an algorithm for the management of category II fetal heart tracings. *fetal stimulation: digital scalp stim, vibroacoustic stim* A concern with continuous EFM is the lack of standardization in the FHR tracing interpretation.5,811 Studies demonstrate poor inter-rater reliability of experts, even in controlled research settings.12,13 A National Institute of Child Health and Human Development (NICHD) research planning workshop was convened in 1997 to standardize definitions for interpretation of EFM tracing.14 These definitions were adopted by the American College of Obstetricians and Gynecologists (ACOG) in 2002,5 and revisions were made in a 2008 workshop sponsored by NICHD, ACOG, and the Society for Maternal-Fetal Medicine.11 The Advanced Life Support in Obstetrics (ALSO) curriculum developed the mnemonic DR C BRAVADO (Table 3) to teach a systematic, structured approach to continuous EFM interpretation that incorporates the NICHD definitions.9,11. Palpate for uterine contraction during period of FHR auscultation to determine relationship, 5. Contractions cause an increase in uterine venous pressure and a decrease in uterine artery perfusion. You should first. 140 Correct . Another area of interest is the use of computer analysis for key components of the fetal tracing,29 or decision analysis for the interpretation of the EFM tracing.30 These have not been demonstrated to improve clinical outcomes.29,30 Fetal pulse oximetry was developed to continuously monitor fetal oxygenation during labor by using an internal monitor, requiring rupture of membranes.31 Trials have not demonstrated a reduction in cesarean delivery rates or interventions with the use of fetal pulse oximetry.31. FHR: fetal heart rate; bpm: beats per minute. The Fetal Heart Rate Tracing SecondLookTM mobile application with three complete sets can be downloaded for free from the iTunes and Google Play app stores. 2015;43(4):198-203. doi:10.1249/JES.0000000000000058. Variable. Currently she serves as President of the Association of Professors of Gynecology and Obstetrics (APGO). Assuming the same amount of 14C{ }^{14} \mathrm{C}14C was initially present in the artifact as is now contained in the fresh sample, determine the age of the artifact. 2023 Annual Clinical & Scientific Meeting, Congressional Leadership Conference (CLC), Countdown to Intern Year, Week 4: Fetal Heart Tracings, Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles, Management of Intrapartum Fetal Heart Rate Tracings, Anti-Racism Resources: Articles, Videos, Podcasts, Novels Etc, Alliance for Innovation on Maternal Health, Postpartum Contraceptive Access Initiative, Baseline fetal heart rate (FHR) variability, Changes or trends of FHR patterns over time, Frequency and intensity of uterine contractions, Normal: five contractions or less in 10 minutes, averaged over a 30-minute window, Tachysystole: more than five contractions in 10 minutes, averaged over a 30-minute window, Always include presence or absence of associated FHR decelerations, Applies to both spontaneous and stimulated labor. From time to time the app may be updated with revised content. Absent baseline FHR variability and any of the following: We encourage ALL students to educate themselves about racism in America today and have included a list of-anti-racism resources here: Your Junior Fellow Advisory Council recently chimed in with their advice for surviving and succeeding during intern year. Bradycardia not accompanied by absent baseline variability, Absent baseline variability with no recurrent decelerations, Absence of induced accelerations after fetal stimulation, Recurrent variable decelarations accompanied by minimal or moderate baseline variability, Prolonged deceleration more than 2 minutes but less than 10 minutes, Recurrent late declarations with moderate baseline variability, Variable decelerations with other characteristics such as slow return to baseline, overshoots, or "shoulders". By accessing any content on this site or its related media channels, you agree never to hold us liable for damages, harm, loss, or misinformation. Question 1: Sinusoidal fetal heart rate (cat iii FHR tracing) = repetitive, wave like fluctuations with absent variability and no response to contractions. Must be for a minimum of 2 minutes in any 10-minute segment. Assess maternal vital signs (temperature, blood pressure, pulse), 3. Copyright 2009 by the American Academy of Family Physicians. While it can be an important tool to assess fetal wellbeing, it is also limited by its high false-positive rate. Discontinue oxytocin (Pitocin) infusion, if in use, 4. FHR baseline usually ranges from 120-160 beats per minute (bpm); however, with fetal decelerations, the heart rate usually drops about 40bpm below baseline. University of Rochester Medical Center. Basic 5 areas to cover in FHR description: -mean FHR rounded to increments of 5bpm in 10 min segment, excluding: visually apparent increases (onset to peak in less than 30 seconds) in FHR from most recently calculated baseline, Stimulation of fetal scalp by digital exam should cause, HR acceleration in normal fetus w arterial fetal pH >7.2, Guidelines for intrapartum fetal monitoring: continuous electronic in low and high risk, *first stage: cervix thins and opens* 1. Nearly 100 years later, they found that very low heart rate (bradycardia) indicated fetal distress. Prenatal care in your first trimester. Correct. Onset, depth, and duration commonly vary with successive uterine contractions. Thank you, {{form.email}}, for signing up. It takes that professionals understanding of what the continuous tracings show to properly assess the fetal condition. The Fetal Heart Rate Tracing SecondLookTM app consists of three slide sets, which cover the basic interpretation of FHR tracings including the determination of baseline and variability, various types of acceleration and decelerations, and some examples and practice cases. Your obstetrician reviews the fetal heart tracing at regular time intervals. Ectopic Pregnancy Quiz Questions And Answers. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Journal of Ultrasound in Medicine. The physiology behind late deceleration is uteroplacental insufficiency.16,17 Transient late deceleration patterns may be seen with maternal hypotension or uterine hyperstimulation. Detection is most accurate with a direct fetal scalp electrode, although newer external transducers have improved the ability to detect variability. What are the two most important characteristics of the FHR? The American College of Obstetrics and Gynecologists. Fetal heart rate is a term that refers to a baby's heartbeat while they're in the uterus. 2018;38(5):1327-1331. doi:10.1002/jum.14813. Fluorescent-labeled lineage tracing revealed that 1 week after transplantation, green fluorescent protein (GFP)-MSCs were found to migrate to the bone surface (BS) in control mice but not in DIO mice. I actually went over the Second Look (files) twice - once immediately after doing the lecture and lab to help reinforce what I learned, and then again before the exam as a review. Ordinarily, your babys heart beats at a faster rate in the late stage of pregnancy, when theyre especially active. Please try reloading page. abrupt: onset to nadir <30 sec, *uterine contractions/fetal head compression* *NO late or variable decels* See our full, Click to share on Facebook (Opens in new window), Click to share on Twitter (Opens in new window), Click to share on Pinterest (Opens in new window), Click to share on Reddit (Opens in new window), Click to share on LinkedIn (Opens in new window), Click to share on WhatsApp (Opens in new window), Click to share on Pocket (Opens in new window), Click to share on Telegram (Opens in new window), Click to share on Skype (Opens in new window), IV Drug Use Complications & Dangers: (Endocarditis, Infection, Infectious Diseases). Whats a Normal Fetal Heart Rate During Pregnancy? Monitoring fetal heart rate during pregnancy has been a focus for doctors and midwives since the 1800s. They last for longer than 15 seconds. early decels present or absent What reassuring sign is missing? The first uses Doppler ultrasound to monitor FHR patterns, while the second measures the duration and frequency of uterine contractions. Enter your email address below and hit "Submit" to receive free email updates and nursing tips. fluid to the laboratory to screen the client for chlamydia b. send a sample of amniotic fluid to the laboratory to test for an elevated Rh-negative titer c. administer immune . Differentiate maternal pulse from. Structured intermittent auscultation is a technique that employs the systematic use of a Doppler assessment of fetal heart rate (FHR) during labor at defined timed intervals (Table 1).4 It is equivalent to continuous EFM in screening for fetal compromise in low-risk patients.2,3,5 Safety in using structured intermittent auscultation is based on a nurse-to-patient ratio of 1:1 and an established technique for intermittent auscultation for each institution.4 Continuous EFM should be used when there are abnormalities in structured intermittent auscultation or for high-risk patients (Table 2).4 An admission tracing of electronic FHR in low-risk pregnancy increases intervention without improved neonatal outcomes, and routine admission tracings should not be used to determine monitoring technique.6.
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