The SurePulse VS uses reflective photoplethysmography (PPG) which is a similar technique to a pulse oximeter (transmission PPG), but it utilises green light. The sensor rests on the forehead detecting blood volume changes under the skin on the forehead. 

Using green light provides a more accurate and reliable HR assessment than red/infrared light.

Reflectance PPG means that the forehead can be used for HR assessment, and the forehead capillary bed bloodflow is maintained (from the carotid artery) even when the baby’s extremities/limbs may be poorly perfused (Grubb et al 2014).

SurePulse VS provides wireless, accurate and continuous heart rate information (to within 5 beats per minute of ECG) (Henry et al, 2020)

The SurePulse VS provides continuous and accurate heart rate and pulse waveform information (within 5 beats per minute of ECG) (Grubb et al, 2024).

ECG leads can cause skin-stripping and consequent scarring and infection risk (Dawson et al, 2018).

Vernix on a newborn baby can also make it difficult to get appropriate contact with ECG electrodes (and the need to reapply the electrodes is common) 

Electrode wires are often inconvenient when managing a newborn baby (for example when a baby is put into a thermoprotective bag).  

There have been recent reported cases of Pulseless Electrical Activity (PEA) where the electrical activity of the heart does not result in contraction of the heart muscle, and therefore ECG alone may not always be a reliable indicator of cardiac output (Luong et al 2019). As the PPG pulse waveform (trace) on the SurePulse VS Display screen matches the blood flow across the baby’s forehead, it shows whether or not the heart is actually pumping blood (cardiac output).  

• Pulse Oximetry (PO) was developed to provide oxygen saturation information and not heart rate (HR), for which it has been reported to be less accurate than ECG ( Iglesias et al, 2018 & Kamlin et al, 2008). The PO probe is usually attached to the newborn baby’s right wrist (pre-ductal), however an accurate and reliable HR relies on good perfusion which is often not present in the extremities in premature, poorly or unresponsive babies. In poorly perfused newborn babies blood is preferentially directed to the head, heart and vital organs in preference to the extremities, underlying the advantage of the SurePulse VS forehead-based approach. 

• In an observational study (Kolstad et al, 2023) of 230 newborn babies needing resuscitation, a ‘useful’ HR assessed by PO was observed for only 33% of babies for the first 10 minutes and only 5% when babies were being ventilated (Kolstad et al, 2010).

The stethoscope is frequently used in the delivery room, and whilst it is very low-cost, it is well documented that stethoscope-assessed heart rates in the delivery room are inaccurate to the extent that incorrect clinical intervention decisions are indicated in up to 1/3 of assessments (Voogdt, 2010).