Background: The most recent guidelines by the Neonatal Resuscitation Program recommend use of electrocardiography monitoring during advanced resuscitation. Objective: We describe a case in whom detection of pulseless electrical activity (PEA) on electronic heart rate monitoring complicated delivery room management of an extremely low birth weight infant and offer suggestions for the identification of PEA for neonatal providers. Conclusion: Further prospective studies are needed to determine the true incidence of PEA in the delivery room setting as well as its prognosis in newborns.

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