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Scahill MD, Chock V, Travis K, Lazarus M, Helfenbein E, Scala M. Sample entropy correlates with intraventricular hemorrhage and mortality in premature infants early in life. Pediatr Res 2024:10.1038/s41390-024-03075-w. [PMID: 38365874 DOI: 10.1038/s41390-024-03075-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/08/2023] [Accepted: 01/02/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Mortality and intraventricular hemorrhage (IVH) are common adverse outcomes in preterm infants and are challenging to predict clinically. Sample entropy (SE), a measure of heart rate variability (HRV), has shown predictive power for sepsis and other morbidities in neonates. We evaluated associations between SE and mortality and IVH in the first week of life. METHODS Participants were 389 infants born before 32 weeks of gestation for whom bedside monitor data were available. A total of 29 infants had IVH grade 3 or 4 and 31 infants died within 2 weeks of life. SE was calculated with the PhysioNet open-source benchmark. Logistic regressions assessed associations between SE and IVH and/or mortality with and without common clinical covariates over various hour of life (HOL) censor points. RESULTS Lower SE was associated with mortality by 4 HOL, but higher SE was very strongly associated with IVH and mortality at 24-96 HOL. Bootstrap testing confirmed SE significantly improved prediction using clinical variables at 96 HOL. CONCLUSION SE is a significant predictor of IVH and mortality in premature infants. Given IVH typically occurs in the first 24-72 HOL, affected infants may initially have low SE followed by a sustained period of high SE. IMPACT SE correlates with IVH and mortality in preterm infants early in life. SE combined with clinical factors yielded ROC AUCs well above 0.8 and significantly outperformed the clinical model at 96 h of life. Previous studies had not shown predictive power over clinical models. First study using the PhysioNet Cardiovascular Toolbox benchmark in young infants. Relative to the generally accepted timing of IVH in premature infants, we saw lower SE before or around the time of hemorrhage and a sustained period of higher SE after. Higher SE after acute events has not been reported previously.
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Affiliation(s)
- Michael D Scahill
- Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Valerie Chock
- Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Katherine Travis
- Developmental Behavioral Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Molly Lazarus
- Developmental Behavioral Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Eric Helfenbein
- Advanced Algorithm Research Center, Hospital Patient Monitoring, Philips Healthcare, Sunnyvale, CA, USA
| | - Melissa Scala
- Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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Chevalier G, Garabedian C, Pekar JD, Wojtanowski A, Le Hesran D, Galan LE, Sharma D, Storme L, Houfflin-Debarge V, De Jonckheere J, Ghesquière L. Early heart rate variability changes during acute fetal inflammatory response syndrome: An experimental study in a fetal sheep model. PLoS One 2023; 18:e0293926. [PMID: 38032884 PMCID: PMC10688759 DOI: 10.1371/journal.pone.0293926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/21/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Fetal infection during labor with fetal inflammatory response syndrome (FIRS) is associated with neurodevelopmental disabilities, cerebral palsy, neonatal sepsis, and mortality. Current methods to diagnose FIRS are inadequate. Thus, the study aim was to explore whether fetal heart rate variability (HRV) analysis can be used to detect FIRS. MATERIAL AND METHODS In chronically instrumented near-term fetal sheep, lipopolysaccharide (LPS) was injected intravenously to model FIRS. A control group received saline solution injection. Hemodynamic, blood gas analysis, interleukin-6 (IL-6), and 14 HRV indices were recorded for 6 h. In both groups, comparisons were made between the stability phase and the 6 h following injection (H1-H6, respectively) and between LPS and control groups. RESULTS Fifteen lambs were instrumented. In the LPS group (n = 8), IL-6 increased significantly after LPS injection (p < 0.001), confirming the FIRS model. Fetal heart rate increased significantly after H5 (p < 0.01). In our FIRS model without shock or cardiovascular decompensation, five HRV measures changed significantly after H2 until H4 in comparison to baseline. Moreover, significant differences between LPS and control groups were observed in HRV measures between H2 and H4. These changes appear to be mediated by an increase of global variability and a loss of signal complexity. CONCLUSION As significant HRV changes were detected before FHR increase, these indices may be valuable for early detection of acute FIRS.
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Affiliation(s)
- Geoffroy Chevalier
- ULR 2694—METRICS—Evaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, France
- Department of Obstetrics, CHU Lille, France
| | - Charles Garabedian
- ULR 2694—METRICS—Evaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, France
- Department of Obstetrics, CHU Lille, France
| | | | | | | | | | - Dyuti Sharma
- ULR 2694—METRICS—Evaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, France
- Department of Pediatric Surgery, CHU Lille, France
| | - Laurent Storme
- ULR 2694—METRICS—Evaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, France
- Department of Neonatology, CHU Lille, France
| | - Veronique Houfflin-Debarge
- ULR 2694—METRICS—Evaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, France
- Department of Obstetrics, CHU Lille, France
| | - Julien De Jonckheere
- ULR 2694—METRICS—Evaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, France
- CIC-IT 1403, CHU Lille, France
| | - Louise Ghesquière
- ULR 2694—METRICS—Evaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, France
- Department of Obstetrics, CHU Lille, France
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Lear CA, Ugwumadu A, Bennet L, Gunn AJ. An Update of Our Understanding of Fetal Heart Rate Patterns in Health and Disease. Semin Pediatr Neurol 2023; 47:101072. [PMID: 37919038 DOI: 10.1016/j.spen.2023.101072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 11/04/2023]
Abstract
UNDERSTANDING FETAL HEART RATE PATTERNS THAT MAY PREDICT ANTENATAL AND INTRAPARTUM NEURAL INJURY: Christopher A. Lear, Jenny A. Westgate, Austin Ugwumadu, Jan G. Nijhuis, Peter R. Stone, Antoniya Georgieva, Tomoaki Ikeda, Guido Wassink , Laura Bennet , Alistair J. Gunn Seminars in Pediatric Neurology Volume 28, December 2018, Pages 3-16 Electronic fetal heart rate (FHR) monitoring is widely used to assess fetal well-being throughout pregnancy and labor. Both antenatal and intrapartum FHR monitoring are associated with a high negative predictive value and a very poor positive predictive value. This in part reflects the physiological resilience of the healthy fetus and the remarkable effectiveness of fetal adaptations to even severe challenges. In this way, the majority of "abnormal" FHR patterns in fact reflect a fetus' appropriate adaptive responses to adverse in utero conditions. Understanding the physiology of these adaptations, how they are reflected in the FHR trace and in what conditions they can fail is therefore critical to appreciating both the potential uses and limitations of electronic FHR monitoring.
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Affiliation(s)
- Christopher A Lear
- The Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Austin Ugwumadu
- Department of Obstetrics and Gynaecology, St George's Hospital, St George's University of London, London, UK
| | - Laura Bennet
- The Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Alistair J Gunn
- The Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand.
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Frasch MG. Heart Rate Variability Code: Does It Exist and Can We Hack It? Bioengineering (Basel) 2023; 10:822. [PMID: 37508849 PMCID: PMC10375964 DOI: 10.3390/bioengineering10070822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/13/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
A code is generally defined as a system of signals or symbols for communication. Experimental evidence is synthesized for the presence and utility of such communication in heart rate variability (HRV) with particular attention to fetal HRV: HRV contains signatures of information flow between the organs and of response to physiological or pathophysiological stimuli as signatures of states (or syndromes). HRV exhibits features of time structure, phase space structure, specificity with respect to (organ) target and pathophysiological syndromes, and universality with respect to species independence. Together, these features form a spatiotemporal structure, a phase space, that can be conceived of as a manifold of a yet-to-be-fully understood dynamic complexity. The objective of this article is to synthesize physiological evidence supporting the existence of HRV code: hereby, the process-specific subsets of HRV measures indirectly map the phase space traversal reflecting the specific information contained in the code required for the body to regulate the physiological responses to those processes. The following physiological examples of HRV code are reviewed, which are reflected in specific changes to HRV properties across the signal-analytical domains and across physiological states and conditions: the fetal systemic inflammatory response, organ-specific inflammatory responses (brain and gut), chronic hypoxia and intrinsic (heart) HRV (iHRV), allostatic load (physiological stress due to surgery), and vagotomy (bilateral cervical denervation). Future studies are proposed to test these observations in more depth, and the author refers the interested reader to the referenced publications for a detailed study of the HRV measures involved. While being exemplified mostly in the studies of fetal HRV, the presented framework promises more specific fetal, postnatal, and adult HRV biomarkers of health and disease, which can be obtained non-invasively and continuously.
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Affiliation(s)
- Martin Gerbert Frasch
- Department of Obstetrics and Gynecology and Institute on Human Development and Disability, University of Washington School of Medicine, Seattle, WA 98195, USA
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Layton R, Layton D, Beggs D, Fisher A, Mansell P, Stanger KJ. The impact of stress and anesthesia on animal models of infectious disease. Front Vet Sci 2023; 10:1086003. [PMID: 36816193 PMCID: PMC9933909 DOI: 10.3389/fvets.2023.1086003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023] Open
Abstract
Stress and general anesthesia have an impact on the functional response of the organism due to the detrimental effects on cardiovascular, immunological, and metabolic function, which could limit the organism's response to an infectious event. Animal studies have formed an essential step in understanding and mitigating infectious diseases, as the complexities of physiology and immunity cannot yet be replicated in vivo. Using animals in research continues to come under increasing societal scrutiny, and it is therefore crucial that the welfare of animals used in disease research is optimized to meet both societal expectations and improve scientific outcomes. Everyday management and procedures in animal studies are known to cause stress, which can not only cause poorer welfare outcomes, but also introduces variables in disease studies. Whilst general anesthesia is necessary at times to reduce stress and enhance animal welfare in disease research, evidence of physiological and immunological disruption caused by general anesthesia is increasing. To better understand and quantify the effects of stress and anesthesia on disease study and welfare outcomes, utilizing the most appropriate animal monitoring strategies is imperative. This article aims to analyze recent scientific evidence about the impact of stress and anesthesia as uncontrolled variables, as well as reviewing monitoring strategies and technologies in animal models during infectious diseases.
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Affiliation(s)
- Rachel Layton
- Australian Centre for Disease Preparedness, CSIRO, Geelong, VIC, Australia,*Correspondence: Rachel Layton ✉
| | - Daniel Layton
- Australian Centre for Disease Preparedness, CSIRO, Geelong, VIC, Australia
| | - David Beggs
- Faculty of Veterinary and Agricultural Sciences, Melbourne Veterinary School, University of Melbourne, Melbourne, VIC, Australia
| | - Andrew Fisher
- Faculty of Veterinary and Agricultural Sciences, Melbourne Veterinary School, University of Melbourne, Melbourne, VIC, Australia
| | - Peter Mansell
- Faculty of Veterinary and Agricultural Sciences, Melbourne Veterinary School, University of Melbourne, Melbourne, VIC, Australia
| | - Kelly J. Stanger
- Australian Centre for Disease Preparedness, CSIRO, Geelong, VIC, Australia
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Turini L, Bonelli F, Lanatà A, Vitale V, Nocera I, Sgorbini M, Mele M. Validation of a new smart textiles biotechnology for heart rate variability monitoring in sheep. Front Vet Sci 2022; 9:1018213. [DOI: 10.3389/fvets.2022.1018213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/26/2022] [Indexed: 11/23/2022] Open
Abstract
Robust Animal-Based Measures (ABMs) are fundamental in order to assess animal welfare, however in semi-extensive sheep farming systems is not easy to collect ABMs without inducing additional stress in the animals. Heart rate variability (HRV) is a non-invasive technique of assessing stress levels related to animal welfare. It is considered a sensitive indicator of the functional regulatory characteristics of the autonomic nervous system. Several studies investigated the use of HRV for welfare assessment in dairy cows while research on sheep is scarce. Moreover, assessing HRV in small ruminants at pasture is critical because of the lack of a solution adoptable for field conditions. This study aimed to evaluate if a smart textiles technology is comparable to a Standard base-apex electrocardiogram (ECG) for measuring HRV in small ruminants. Eight healthy Massese dairy sheep were recruited. Standard base-apex ECG and smart textiles technology (Smartex ECG) were simultaneously acquired for 5 min in the standing, unsedated, unclipped sheep. The ECG tracings were recorded when animals were standing quietly. The Bland-Altman test and the linear regression analysis were applied after parameter extraction in time, frequency, and non-linear methods to compare Smartex against standard base-apex ECG systems. The Bland-Altman test was applied to all HRV extracted parameters (Mean RR, pNN50, RMSSD, LF/HF, SampEn, SD1, SD2, stdRR) to evaluate the agreement between the two different instruments, and a linear regression analysis was performed to evaluate the relationship between the two methods. The smart textiles biotechnology was simple to wear and clean. It can be worn without using glue and without shaving the sheep's wool, limiting animal handling and stress. Bland Altman test reported a robust agreement between the two systems. In fact, the regression analysis of HRV parameters showed that half of the parameters recorded had an R2 coefficient >0.75. Results also showed a very small reproducibility coefficient that indicated that the two methods were really close to each other. Smartex textiles technology can be used for HRV evaluation in sheep species as a potential ABM for animal welfare assessment.
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Tarvonen MJ, Lear CA, Andersson S, Gunn AJ, Teramo KA. Increased variability of fetal heart rate during labour: a review of preclinical and clinical studies. BJOG 2022; 129:2070-2081. [PMID: 35596699 PMCID: PMC9796294 DOI: 10.1111/1471-0528.17234] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/02/2022] [Accepted: 05/16/2022] [Indexed: 01/01/2023]
Abstract
Increased fetal heart rate variability (FHRV) in intrapartum cardiotocographic recording has been variably defined and poorly understood, limiting its clinical utility. Both preclinical (animal) and clinical (human) evidence support that increased FHRV is observed in the early stage of intrapartum fetal hypoxaemia but can also be observed in a subset of fetuses during the preterminal stage of repeated hypoxaemia. This review of available evidence provides data and expert opinion on the pathophysiology of increased FHRV, its clinical significance and a stepwise approach regarding the management of this pattern, and propose recommendations for standardisation of related terminology.
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Affiliation(s)
- Mikko J. Tarvonen
- Department of Obstetrics and GynaecologyUniversity of Helsinki, and Helsinki University HospitalHelsinkiFinland
| | - Christopher A. Lear
- Fetal Physiology and Neuroscience GroupDepartment of PhysiologyUniversity of AucklandAucklandNew Zealand
| | - Sture Andersson
- Children’s Hospital, Paediatric Research CentreUniversity of Helsinki, and Helsinki University HospitalHelsinkiFinland
| | - Alistair J. Gunn
- Fetal Physiology and Neuroscience GroupDepartment of PhysiologyUniversity of AucklandAucklandNew Zealand
| | - Kari A. Teramo
- Department of Obstetrics and GynaecologyUniversity of Helsinki, and Helsinki University HospitalHelsinkiFinland
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Favrais G, Bokobza C, Saliba E, Chalon S, Gressens P. Alteration of the Oligodendrocyte Lineage Varies According to the Systemic Inflammatory Stimulus in Animal Models That Mimic the Encephalopathy of Prematurity. Front Physiol 2022; 13:881674. [PMID: 35928559 PMCID: PMC9343871 DOI: 10.3389/fphys.2022.881674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022] Open
Abstract
Preterm birth before the gestational age of 32 weeks is associated with the occurrence of specific white matter damage (WMD) that can compromise the neurological outcome. These white matter abnormalities are embedded in more global brain damage defining the encephalopathy of prematurity (EoP). A global reduction in white matter volume that corresponds to chronic diffuse WMD is the most frequent form in contemporary cohorts of very preterm infants. This WMD partly results from alterations of the oligodendrocyte (OL) lineage during the vulnerability window preceding the beginning of brain myelination. The occurrence of prenatal, perinatal and postnatal events in addition to preterm birth is related to the intensity of WMD. Systemic inflammation is widely recognised as a risk factor of WMD in humans and in animal models. This review reports the OL lineage alterations associated with the WMD observed in infants suffering from EoP and emphasizes the role of systemic inflammation in inducing these alterations. This issue is addressed through data on human tissue and imaging, and through neonatal animal models that use systemic inflammation to induce WMD. Interestingly, the OL lineage damage varies according to the inflammatory stimulus, i.e., the liposaccharide portion of the E.Coli membrane (LPS) or the proinflammatory cytokine Interleukin-1β (IL-1β). This discrepancy reveals multiple cellular pathways inducible by inflammation that result in EoP. Variable long-term consequences on the white matter morphology and functioning may be speculated upon according to the intensity of the inflammatory challenge. This hypothesis emerges from this review and requires further exploration.
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Affiliation(s)
- Geraldine Favrais
- UMR 1253, iBrain, Inserm, Université de Tours, Tours, France
- Neonatology Unit, CHRU de Tours, Tours, France
- *Correspondence: Geraldine Favrais,
| | - Cindy Bokobza
- Inserm, NeuroDiderot, Université Paris Cité, Paris, France
| | - Elie Saliba
- UMR 1253, iBrain, Inserm, Université de Tours, Tours, France
| | - Sylvie Chalon
- UMR 1253, iBrain, Inserm, Université de Tours, Tours, France
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Frasch MG. Heart Rate as a Non-Invasive Biomarker of Inflammation: Implications for Digital Health. Front Immunol 2022; 13:930445. [PMID: 35720409 PMCID: PMC9201903 DOI: 10.3389/fimmu.2022.930445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Martin G Frasch
- Department of OBGYN and Center on Human Development and Disability (CHDD), University of Washington, Seattle, WA, United States
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