1
|
Shiono A, Bonno M, Toyoda H, Ogawa M, Tanaka S, Hirayama M. Autonomic Nervous System in Preterm Very Low Birth Weight Neonates with Intraventricular Hemorrhage. Am J Perinatol 2024; 41:e577-e583. [PMID: 35977712 DOI: 10.1055/a-1926-0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Heart rate variability (HRV) indicates cardiac autonomic nerve activity and is influenced by brain damage during the neonatal period. We aimed to determine whether a correlation exists between the HRV of extremely preterm neonates and neurodevelopmental test scores. STUDY DESIGN Electrocardiogram data of neonates were assessed and HRV patterns in extremely preterm neonates with severe intraventricular hemorrhage (IVH; n = 6) and those with no/mild IVH (n = 28) were compared. We analyzed the relationship between HRV and neurodevelopmental outcomes at 18 months (n = 21) and 3 years (n = 23) in extremely preterm neonates. RESULTS HRV was significantly associated with IVH severity in extremely preterm neonates (p < 0.05). Neonates with severe IVH exhibited increased HR and decreased mean R-to-R interval (NN) compared with neonates with no/mild IVH. HRV parameters significantly decreased in the severe IVH group, but not in the no/mild IVH group, suggesting that both sympathetic and parasympathetic activities decreased in neonates with severe IVH. Additionally, decreased HR and increased NN were significantly related to impaired neurodevelopmental outcomes in the no/mild IVH group at corrected ages of 18 months and 3 years, respectively (all p < 0.05). CONCLUSION HRV was significantly associated with IVH severity and neurodevelopmental outcome in extremely preterm neonates. HRV can distinguish extremely preterm neonates who subsequently had severe IVH from those who had no/low-grade IVH. HRV may identify extremely preterm neonates needing adjuvant neuroprotective interventions. These findings warrant further investigation in a larger population of extremely preterm neonates. KEY POINTS · HRV was associated with IVH severity.. · HRV can predict subsequent severe IVH in extremely preterm neonates.. · HRV are predictive of neurodevelopmental outcomes in extremely premature neonates with low-grade IVH..
Collapse
Affiliation(s)
- Ai Shiono
- Department of Neonatology and Pediatrics, National Hospital Organization Mie Chuo Medical Center, Mie, Japan
- Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan
| | - Motoki Bonno
- Department of Neonatology and Pediatrics, National Hospital Organization Mie Chuo Medical Center, Mie, Japan
| | - Hidemi Toyoda
- Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan
| | - Masahiro Ogawa
- Department of Neonatology and Pediatrics, National Hospital Organization Mie Chuo Medical Center, Mie, Japan
| | - Shigeki Tanaka
- Department of Neonatology and Pediatrics, National Hospital Organization Mie Chuo Medical Center, Mie, Japan
| | - Masahiro Hirayama
- Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan
| |
Collapse
|
2
|
Melaet R, de Vries IR, Kok RD, Guid Oei S, Huijben IAM, van Sloun RJG, O E H van Laar J, Vullings R. Artificial intelligence based cardiotocogram assessment during labor. Eur J Obstet Gynecol Reprod Biol 2024; 295:75-85. [PMID: 38340594 DOI: 10.1016/j.ejogrb.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/22/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To assess whether artificial intelligence, inspired by clinical decision-making procedures in delivery rooms, can correctly interpret cardiotocographic tracings and distinguish between normal and pathological events. STUDY DESIGN A method based on artificial intelligence was developed to determine whether a cardiotocogram shows a normal response of the fetal heart rate to uterine activity (UA). For a given fetus and given the UA and previous FHR, the method predicts a fetal heart rate response, under the assumption that the fetus is still in good condition and based on how that specific fetus has responded so far. We hypothesize that this method, when having only learned from fetuses born in good condition, is incapable of predicting the response of a compromised fetus or an episode of transient fetal distress. The (in)capability of the method to predict the fetal heart rate response would then yield a method that can help to assess fetal condition when the obstetrician is in doubt. Cardiotocographic data of 678 deliveries during labor were selected based on a healthy outcome just after birth. The method was trained on the cardiotocographic data of 548 fetuses of this group to learn their heart rate response. Subsequently it was evaluated on 87 fetuses, by assessing whether the method was able to predict their heart rate responses. The remaining 43 cardiotocograms were segment-by-segment annotated by three experienced gynecologists, indicating normal, suspicious, and pathological segments, while having access to the full recording and neonatal outcome. This future knowledge makes the expert annotations of a quality that is unachievable during live interpretation. RESULTS The comparison between abnormalities detected by the method (only using past and present input) and the annotated CTG segments by gynecologists (also looking at future input) yields an area under the curve of 0.96 for the distinction between normal and pathological events in majority-voted annotations. CONCLUSION The developed method can distinguish between normal and pathological events in near real-time, with a performance close to the agreement between three gynecologists with access to the entire CTG tracing and fetal outcome. The method has a strong potential to support clinicians in assessing fetal condition in clinical practice.
Collapse
Affiliation(s)
- Raoul Melaet
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Nemo Healthcare BV, Veldhoven, the Netherlands
| | - Ivar R de Vries
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Nemo Healthcare BV, Veldhoven, the Netherlands.
| | - René D Kok
- Nemo Healthcare BV, Veldhoven, the Netherlands
| | - S Guid Oei
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Iris A M Huijben
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Ruud J G van Sloun
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Judith O E H van Laar
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Rik Vullings
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Nemo Healthcare BV, Veldhoven, the Netherlands
| |
Collapse
|
3
|
Mercado L, Escalona-Vargas D, Siegel ER, Preissl H, Bolin EH, Eswaran H. Exploring the Influence of Fetal Sex on Heart Rate Dynamics Using Fetal Magnetocardiographic Recordings. Reprod Sci 2024; 31:823-831. [PMID: 37884730 DOI: 10.1007/s43032-023-01384-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023]
Abstract
Fetal sex has been associated with different development trajectories that cause structural and functional differences between the sexes throughout gestation. Fetal magnetocardiography (fMCG) recordings from 123 participants (64 females and 59 males; one recording/participant) from a database consisting of low-risk pregnant women were analyzed to explore and compare fetal development trajectories of both sexes. The gestational age of the recordings ranged from 28 to 38 weeks. Linear metrics in both the time and frequency domains were applied to study fetal heart rate variability (fHRV) measures that reveal the dynamics of short- and long-term variability. Rates of linear change with GA in these metrics were analyzed using general linear model regressions with assessments for significantly different variances and GA regression slopes between the sexes. The fetal sexes were well balanced for GA and sleep state. None of the fHRV measures analyzed exhibited significant variance heterogeneity between the sexes, and none of them exhibited a significant sex-by-GA interaction. The absence of a statistically significant sex-by-GA interaction on all parameters resulted in none of the regression slope estimates being significantly different between the sexes. With high-precision fMCG recordings, we were able to explore the variation in fHRV parameters as it relates to fetal sex. The fMCG-based fHRV parameters did not show any significant difference in rates of change with gestational age between sexes. This study provides a framework for understanding normal development of the fetal autonomic nervous system, especially in the context of fetal sex.
Collapse
Affiliation(s)
- Luis Mercado
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Diana Escalona-Vargas
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, AR, USA
| | - Eric R Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Hubert Preissl
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the Eberhard Karls University of Tübingen, fMEG Center, Tübingen, Germany
| | - Elijah H Bolin
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, AR, USA
| | - Hari Eswaran
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA.
| |
Collapse
|
4
|
Kuderava Z, Kozar M, Visnovcova Z, Ferencova N, Tonhajzerova I, Prsova L, Zibolen M. Sympathetic nervous system activity and pain-related response indexed by electrodermal activity during the earliest postnatal life in healthy term neonates. Physiol Res 2023; 72:393-401. [PMID: 37449751 PMCID: PMC10668994 DOI: 10.33549/physiolres.935061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/16/2023] [Indexed: 08/26/2023] Open
Abstract
Sympathetic nervous system (SNS) undergoes a prolonged period of fetal and neonatal development and maturation during which is vulnerable to a variety of influences (e.g. painful experiences). Thus, we aimed to evaluate SNS activity at rest and in response to stressful stimulus (pain) within the earliest postnatal life in healthy term neonates using electrodermal activity (EDA) measures. In twenty eutrophic healthy term neonates EDA was recorded within the first two hours after birth (measurement 1 - M1) and 72 h after birth (measurement 2 - M2) at rest and in response to pain (M1 - intramuscular K vitamin administration; M2 - heel stick). Evaluated parameters were skin conductance level (SCL), non-specific skin conductance responses (NS.SCRs), skin SCL 10 s before pain stimulus (SCL_10 before pain), skin conductance response (SCR) peak after pain stimulus, SCL 10 s after pain stimulus (SCL_10 after pain), SCR magnitude, latency, SCR rise/decline time, SCR half recovery time. SCL was significantly decreased at rest during M2 compared to M1 (p=0.010). SCL_10 before pain, SCR peak after pain, and SCL_10 after pain stimulus were significantly decreased in M2 compared to M1 (p=0.014, p=0.020, p=0.011, respectively). SCL was significantly decreased and NS.SCRs were significantly higher in the recovery period after the pain stimulus during M2 compared to M1 (p=0.015, p=0.032, respectively). Our results indicate EDA parameters sensitive to detect sympathetic changes during the earliest postnatal life reflecting its potential in early diagnosis of the autonomic maturation - linked pathological states in neonates.
Collapse
Affiliation(s)
- Z Kuderava
- Department of Neonatology, University Hospital in Martin and Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic.
| | | | | | | | | | | | | |
Collapse
|
5
|
Ruigrok TJH, Mantel SA, Orlandini L, de Knegt C, Vincent AJPE, Spoor JKH. Sympathetic components in left and right human cervical vagus nerve: implications for vagus nerve stimulation. Front Neuroanat 2023; 17:1205660. [PMID: 37492698 PMCID: PMC10364449 DOI: 10.3389/fnana.2023.1205660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/20/2023] [Indexed: 07/27/2023] Open
Abstract
Cervical vagus nerve stimulation is in a great variety of clinical situations indicated as a form of treatment. It is textbook knowledge that at the cervical level the vagus nerve contains many different fiber classes. Yet, recently, several reports have shown that this nerve also may contain an additional class of potentially noradrenergic fibers, suggested to denote efferent sympathetic fibers. As such, the nature and presence of these fibers should be considered when choosing a stimulation protocol. We have studied human vagus material extracted from dissection room cadavers in order to further confirm the presence of this class of fibers, to study their origin and direction within the nerve and to determine their distribution and variability between subjects and pairs of left and right nerves of the same individual. Sections were studied with immunohistochemical techniques using antibodies against tyrosine hydroxylase (TH: presumed to indicate noradrenergic fibers), myelin basic protein and neurofilament. Our results show that at least part of the TH-positive fibers derive from the superior cervical ganglion or sympathetic trunk, do not follow a cranial but take a peripheral course through the nerve. The portion of TH-positive fibers is highly variable between individuals but also between the left and right pairs of the same individual. TH-positive fibers can distribute and wander throughout the fascicles but maintain a generally clustered appearance. The fraction of TH-positive fibers generally diminishes in the left cervical vagus nerve when moving in a caudal direction but remains more constant in the right nerve. These results may help to determine optimal stimulation parameters for cervical vagus stimulation in clinical settings.
Collapse
Affiliation(s)
- Tom J. H. Ruigrok
- Department of Neuroscience, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Sophia A. Mantel
- Department of Neuroscience, Erasmus MC, University Medical Center, Rotterdam, Netherlands
- Department of Neurosurgery, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Lara Orlandini
- Department of Neuroscience, Erasmus MC, University Medical Center, Rotterdam, Netherlands
- Department of Neurosurgery, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Corné de Knegt
- Department of Neuroscience, Erasmus MC, University Medical Center, Rotterdam, Netherlands
- Department of Neurosurgery, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | | | - Jochem K. H. Spoor
- Department of Neurosurgery, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| |
Collapse
|
6
|
Katebi N, Sameni R, Rohloff P, Clifford GD. Hierarchical Attentive Network for Gestational Age Estimation in Low-Resource Settings. IEEE J Biomed Health Inform 2023; 27:2501-2511. [PMID: 37027652 PMCID: PMC10482160 DOI: 10.1109/jbhi.2023.3246931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Assessing fetal development is essential to the provision of healthcare for both mothers and fetuses. In low- and middle-income countries, conditions that increase the risk of fetal growth restriction (FGR) are often more prevalent. In these regions, barriers to accessing healthcare and social services exacerbate fetal maternal health problems. One of these barriers is the lack of affordable diagnostic technologies. To address this issue, this work introduces an end-to-end algorithm applied to a low-cost, hand-held Doppler ultrasound device for estimating gestational age (GA), and by inference, FGR. The Doppler ultrasound signals used in this study were collected from 226 pregnancies (45 low birth weight at delivery) between 5 and 9 months GA by lay midwives in highland Guatemala. We designed a hierarchical deep sequence learning model with an attention mechanism to learn the normative dynamics of fetal cardiac activity in different stages of development. This resulted in a state-of-the-art GA estimation performance, with an average error of 0.79 months. This is close to the theoretical minimum for the given quantization level of one month. The model was then tested on Doppler recordings of the fetuses with low birth weight and the estimated GA was shown to be lower than the GA calculated from last menstruation. Thus, this could be interpreted as a potential sign of developmental retardation (or FGR) associated with low birth weight, and referral and intervention may be necessary.
Collapse
|
7
|
Zizzo AR, Kirkegaard I, Uldbjerg N, Hansen J, Mølgaard H. Towards better reliability in fetal heart rate variability using time domain and spectral domain analyses. A new method for assessing fetal neurological state? PLoS One 2022; 17:e0263272. [PMID: 35231034 PMCID: PMC8887753 DOI: 10.1371/journal.pone.0263272] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/14/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Fetal heart rate variability (FHRV) has shown potential in fetal surveillance. Therefore, we aimed to evaluate the reliability of time domain and spectral domain parameters based on non-invasive fetal electrocardiography (NI-FECG). METHOD NI-FECG, with a sampling frequency of 1 kHz, was obtained in 75 healthy, singleton pregnant women between gestational age (GA) 20+0 to 41+0. The recording was divided into a) heart rate pattern (HRP) and b) periods fulfilling certain criteria of stationarity of RR-intervals, termed stationary heart rate pattern (SHRP). Within each recording, the first and the last time series from each HRP with less than 5% artifact correction were analyzed and compared. Standard deviation of normal-to-normal RR-intervals (SDNN), root mean square of successive differences (RMSSD), high frequency power (HF-power), low frequency power (LF-power), and LF-power/HF-power were performed. A multivariate mixed model was used and acceptable reliability was defined as intraclass correlation coefficient (ICC) ≥ 0.80 and a coefficient of variation (CV) ≤ 15%. Based on these results, the CV and ICC were computed if the average of two to six time series was used. RESULTS For GA 28+0 to 34+6, SDNN and RMSSD exhibited acceptable reliability (CV < 15%; ICC > 90%), whereas GA 35+0 to 41+0and 20+0 to 27+6 showed higher CVs. Spectral domain parameters also showed high CVs However, by using the mean value of two to six time series, acceptable reliability in SDNN, RMSSD and HF-power from GA 28+0 was achieved. Stationarity of RR-intervals showed high influence on reliability and SHRP was superior to HRP, whereas the length of the time series showed minor influence. CONCLUSION Acceptable reliability seems achievable in SDNN, RMSSD and HF-power from gestational week 28. However, stationarity of RR-intervals should be considered when selecting time series for analyses.
Collapse
Affiliation(s)
- Anne Rahbek Zizzo
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus N, Denmark
| | - Ida Kirkegaard
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus N, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus N, Denmark
| | - John Hansen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Henning Mølgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| |
Collapse
|
8
|
Rahbek Zizzo A, Kirkegaard I, From Reese C, Hansen J, Uldbjerg N, Mølgaard H. Fetal respiratory movements improve reliability of heart rate variability and suggest a coupling between fetal respiratory arrhythmia and vagal activity. Physiol Rep 2022; 10:e15224. [PMID: 35307959 PMCID: PMC8935276 DOI: 10.14814/phy2.15224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 04/21/2023] Open
Abstract
Fetal heart rate variability (FHRV) reflects autonomic cardiac regulation. The autonomic nervous system constantly adjusts the heart rate to maintain homeostasis. By providing insight into the fetal autonomic state, FHRV has the potential to become an investigational and clinical instrument. However, the method needs standardization and the influence of fetal movements, including fetal respiratory movements, is not well explored. Therefore, in a highly standardized setting, the aim was to evaluate the association between fetal movements and fetal heart rate variability (FHRV) including their impact on reliability. Fetal heart rate was obtained by noninvasive fetal electrocardiography (NI-FECG) and fetal movements by simultaneous ultrasound scanning in 30 healthy singleton pregnant women on two occasions with a maximum interval of 7 days. The standard deviation of normal-to-normal RR-intervals (SDNN), root mean square of successive RR-interval differences (RMDDS), high-frequency power (HF-power), low-frequency power (LF-power), and LF/HF were measured. A multivariate mixed model was used and reliability was defined as acceptable by a coefficient of variance (CV) ≤15% and an intraclass correlation coefficient (ICC) ≥0.80. During time periods with fetal respiratory movements, the highest reliability was achieved. Intra- and inter-observer reliability measurements were very high (CV: 0-9%; ICC ≧ 0.86). Within the same recording, SDNN and RMSSD achieved acceptable reliability (CV: 14-15%; ICC ≧ 0.80). However, day-to-day reliability displayed high CV's. In time periods with fetal respiratory movements, as compared to periods with quiescence RMSSD and HF-power were higher (Ratio: 1.33-2.03) and LF/HF power lower (Ratio: 0.54). In periods with fetal body movements SDNN, RMSSD and HF-power were higher (Ratio: 1.27-1.65). In conclusion, time periods with fetal respiratory movements were associated with high reliability of FHRV analyses and the highest values of parameters supposed to represent vagal activity.
Collapse
Affiliation(s)
- Anne Rahbek Zizzo
- Department of Obstetrics and GynaecologyAarhus University HospitalAarhus NDenmark
| | - Ida Kirkegaard
- Department of Obstetrics and GynaecologyAarhus University HospitalAarhus NDenmark
| | - Camille From Reese
- Department of Obstetrics and GynaecologyAarhus University HospitalAarhus NDenmark
| | - John Hansen
- Department of Health Science and TechnologyAalborg UniversityAalborgDenmark
| | - Niels Uldbjerg
- Department of Obstetrics and GynaecologyAarhus University HospitalAarhus NDenmark
| | - Henning Mølgaard
- Department of CardiologyAarhus University HospitalAarhus NDenmark
| |
Collapse
|
9
|
Prenatal docosahexaenoic acid effect on maternal-infant DHA-equilibrium and fetal neurodevelopment: a randomized clinical trial. Pediatr Res 2022; 92:255-264. [PMID: 34552200 PMCID: PMC8456398 DOI: 10.1038/s41390-021-01742-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/03/2021] [Accepted: 09/05/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Maternal-infant equilibrium occurs when cord blood docosahexaenoic acid (DHA) is less than or equal to maternal DHA at delivery. Equilibrium may be an indicator of sufficient DHA for optimal fetal and infant neurodevelopment. The purpose of this study was to test the effect of maternal DHA supplementation on equilibrium status and fetal neurodevelopment. METHODS Women enrolled between 12 and 20 weeks gestation and were randomized to 200 or 800 mg DHA/day until delivery. Maternal red blood cell (RBC) phospholipids were measured at enrollment, 32 weeks, delivery, and in cord blood at delivery. Fetal neurodevelopment was measured at 32 and 36 weeks gestation. Intent-to-treat analyses were conducted to test differences in equilibrium status by group. Fetal outcomes were assessed by equilibrium status and group. RESULTS Three hundred women enrolled and 262 maternal-infant dyads provided blood samples at delivery. No maternal-infant dyads with maternal RBC-DHA ≤ 6.96% at delivery achieved equilibrium. The incidence of equilibrium was significantly higher in the 800 mg group. There was no effect of maternal group or equilibrium status on fetal neurodevelopment. CONCLUSION The significance of maternal-infant DHA equilibrium remains unknown. Ongoing research will test the effect of treatment group, equilibrium, and nutrient status on infant behavior and brain function. IMPACT Pregnant women who received a higher dose of docosahexaenoic acid (DHA) were more likely to achieve maternal-infant DHA equilibrium at delivery. Equilibrium status had no effect on fetal neurodevelopment in this sample. While DHA is crucial for early life neurodevelopment, the significance of achieving maternal-infant equilibrium above the lower threshold is uncertain. There is a lower threshold of maternal DHA status where maternal-infant DHA equilibrium never occurs. The lack of equilibrium associated with low maternal DHA status may indicate insufficient maternal status for optimal placental transfer.
Collapse
|
10
|
Ponsiglione AM, Cosentino C, Cesarelli G, Amato F, Romano M. A Comprehensive Review of Techniques for Processing and Analyzing Fetal Heart Rate Signals. SENSORS (BASEL, SWITZERLAND) 2021; 21:6136. [PMID: 34577342 PMCID: PMC8469481 DOI: 10.3390/s21186136] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/04/2021] [Accepted: 09/10/2021] [Indexed: 02/07/2023]
Abstract
The availability of standardized guidelines regarding the use of electronic fetal monitoring (EFM) in clinical practice has not effectively helped to solve the main drawbacks of fetal heart rate (FHR) surveillance methodology, which still presents inter- and intra-observer variability as well as uncertainty in the classification of unreassuring or risky FHR recordings. Given the clinical relevance of the interpretation of FHR traces as well as the role of FHR as a marker of fetal wellbeing autonomous nervous system development, many different approaches for computerized processing and analysis of FHR patterns have been proposed in the literature. The objective of this review is to describe the techniques, methodologies, and algorithms proposed in this field so far, reporting their main achievements and discussing the value they brought to the scientific and clinical community. The review explores the following two main approaches to the processing and analysis of FHR signals: traditional (or linear) methodologies, namely, time and frequency domain analysis, and less conventional (or nonlinear) techniques. In this scenario, the emerging role and the opportunities offered by Artificial Intelligence tools, representing the future direction of EFM, are also discussed with a specific focus on the use of Artificial Neural Networks, whose application to the analysis of accelerations in FHR signals is also examined in a case study conducted by the authors.
Collapse
Affiliation(s)
- Alfonso Maria Ponsiglione
- Department of Electrical Engineering and Information Technology (DIETI), University of Naples Federico II, Via Claudio 21, 80125 Naples, Italy; (A.M.P.); (F.A.)
| | - Carlo Cosentino
- Department of Experimental and Clinical Medicine ‘Gaetano Salvatore’, University Magna Graecia of Catanzaro, Viale Tommaso Campanella 185, 88100 Catanzaro, Italy;
| | - Giuseppe Cesarelli
- Department of Chemical, Materials and Production Engineering (DICMaPI), University of Naples Federico II, Piazzale Tecchio 80, 80125 Naples, Italy;
| | - Francesco Amato
- Department of Electrical Engineering and Information Technology (DIETI), University of Naples Federico II, Via Claudio 21, 80125 Naples, Italy; (A.M.P.); (F.A.)
| | - Maria Romano
- Department of Electrical Engineering and Information Technology (DIETI), University of Naples Federico II, Via Claudio 21, 80125 Naples, Italy; (A.M.P.); (F.A.)
| |
Collapse
|
11
|
Zöllkau J, Swiderski L, Schmidt A, Weschenfelder F, Groten T, Hoyer D, Schneider U. The Relationship between Gestational Diabetes Metabolic Control and Fetal Autonomic Regulation, Movement and Birth Weight. J Clin Med 2021; 10:jcm10153378. [PMID: 34362160 PMCID: PMC8348724 DOI: 10.3390/jcm10153378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/13/2021] [Accepted: 07/26/2021] [Indexed: 12/03/2022] Open
Abstract
(1) Background: Maternal metabolic control in gestational diabetes is suggested to influence fetal autonomic control and movement activity, which may have fetal outcome implications. We aimed to analyze the relationship between maternal metabolic control, fetal autonomic heart rate regulation, activity and birth weight. (2) Methods: Prospective noninterventional longitudinal cohort monitoring study accompanying 19 patients with specialist clinical care for gestational diabetes. Monthly fetal magnetocardiography with electro-physiologically-based beat-to-beat heart rate recording for analysis of heart rate variability (HRV) and the ‘fetal movement index’ (FMI) was performed. Data were compared to 167 healthy pregnant women retrieved from our pre-existing study database. (3) Results: Fetal vagal tone was increased with gestational diabetes compared to controls, whereas sympathetic tone and FMI did not differ. Within the diabetic population, sympathetic activation was associated with higher maternal blood-glucose levels. Maternal blood-glucose levels correlated positively with birth weight z scores. FMI showed no correlation with birth weight but attenuated the positive correlation between maternal blood-glucose levels and birth weight. (4) Conclusion: Fetal autonomic control is altered by gestational diabetes and maternal blood-glucose level, even if metabolic adjustment and outcome is comparable to healthy controls.
Collapse
Affiliation(s)
- Janine Zöllkau
- Department of Obstetrics, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.S.); (F.W.); (T.G.); (U.S.)
- Correspondence:
| | - Laura Swiderski
- Department of Obstetrics, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.S.); (F.W.); (T.G.); (U.S.)
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (A.S.); (D.H.)
| | - Alexander Schmidt
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (A.S.); (D.H.)
| | - Friederike Weschenfelder
- Department of Obstetrics, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.S.); (F.W.); (T.G.); (U.S.)
| | - Tanja Groten
- Department of Obstetrics, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.S.); (F.W.); (T.G.); (U.S.)
| | - Dirk Hoyer
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (A.S.); (D.H.)
| | - Uwe Schneider
- Department of Obstetrics, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.S.); (F.W.); (T.G.); (U.S.)
| |
Collapse
|
12
|
Zwanenburg F, Jongbloed MRM, van Geloven N, Ten Harkel ADJ, van Lith JMM, Haak MC. Assessment of human fetal cardiac autonomic nervous system development using color tissue Doppler imaging. Echocardiography 2021; 38:974-981. [PMID: 34018638 PMCID: PMC8252470 DOI: 10.1111/echo.15094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/20/2021] [Accepted: 04/28/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives Functional development of the fetal cardiac autonomic nervous system (cANS) plays a key role in fetal maturation and can be assessed through fetal heart rate variability (fHRV)‐analysis, with each HRV parameter representing different aspects of cANS activity. Current available techniques, however, are unable to assess the fHRV parameters accurately throughout the whole pregnancy. This study aims to test the feasibility of color tissue Doppler imaging (cTDI) as a new ultrasound technique for HRV analysis. Secondly, we explored time trends of fHRV parameters using this technique. Methods 18 healthy singleton fetuses were examined sequentially every 8 weeks from 10 weeks GA onwards. From each examination, 3 cTDI recordings of the four‐chamber view of 10 seconds were retrieved to determine accurate beat‐to‐beat intervals. The fHRV parameters SDNN, RMSSD, SDNN/RMSSD, and pNN10, each representing different functional aspects of the cANS, were measured, and time trends during pregnancy were explored using spline functions within a linear mixed‐effects model. Results In total, 77% (95% Cl 66–87%) of examinations were feasible for fHRV analysis from the first trimester onwards, which is a great improvement compared to other techniques. The technique is able to determine different maturation rates of the fHRV parameters, showing that cANS function, presumably parasympathetic activity, establishes around 20 weeks GA and matures rapidly until 30 weeks GA. Conclusions This is the first study able to assess cANS function through fHRV analysis from the first trimester onwards. The use of cTDI to determine beat‐to‐beat intervals seems feasible in just 3 clips of 10 seconds, which holds promise for future clinical use in assessing fetal well‐being.
Collapse
Affiliation(s)
- Fleur Zwanenburg
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique R M Jongbloed
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Anatomy & Embryology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nan van Geloven
- Department of Biomedical Data Sciences, Section Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Arend D J Ten Harkel
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan M M van Lith
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique C Haak
- Department of Obstetrics and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
13
|
Hoyer D, Schmidt A, Pytlik A, Viehöfer L, Gonçalves H, Amorim-Costa C, Bernardes J, Ayres-de-Campos D, Lobmaier SM, Schneider U. Can fetal heart rate variability obtained from cardiotocography provide the same diagnostic value like from electrophysiological interbeat intervals? Physiol Meas 2021; 42:015006. [PMID: 33147578 DOI: 10.1088/1361-6579/abc791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Fetal heart rate variability (HRV) is widely used for monitoring fetal developmental disturbances. Only expensive fetal magnetocardiography (fMCG) allows the precise recording of the individual fetal heart beat intervals uncovering also highly frequent vagal modulation. In contrast, transabdominal fetal electrocardiography (fECG) suffers from noise overlaying the fetal cardiac signal. Cardiotocography (CTG) is the clinical method of choice, however, based on Doppler ultrasound, improper to resolve single beats concisely. The present work addresses the transferability of established electrophysiological HRV indices to CTG recordings during the fetal maturation period of 20-40 weeks of gestation (WGA). APPROACH We compared (a) HRV indices obtained from fMCG, CTG and fECG of short-term amplitude fluctuations (sAMPs) and long-term amplitude fluctuations (lAMPs) and complexity, and (b) their diagnostic value for identifying maturational age, fetal growth restriction (FGR) and small for gestational age (SGA). We used the functional brain age score (fABAS) and categories of long- and short-term regulation and complexity. MAIN RESULTS Integrating all substudies, we found: (a) indices related to long-term regulation, and with modified meaning and values of short-term regulation and sympathovagal balance (SVB) according to electrophysiological HRV standards can be obtained from CTG. (b) Models using HRV indices calculated from CTG allow the identification of maturational age and discriminate FGR from controls with almost similar precision as electrophysiological means. (c) A modified set of HRV parameters containing short- and long-term regulation and long-term/short-term ratio appeared to be most suitable to describe autonomic developmental state when CTG data is used. SIGNIFICANCE Whereas the predominantly vagally modulated beat-to-beat precise high frequencies of HRV are not assessable from CTG, we identified relevant related HRV indices and categories for CTG recordings with diagnostic potential. They require further evaluation and confirmation with respect to any issues of fetal developmental and perinatal problems in subsequent studies. This methodology significantly extends the measures of established CTG devices. Novelty and significance HRV indices provide predestinated diagnostic markers of autonomic control in fetuses. However, the established CTG does not provide the temporal precision of electrophysiological recordings. Beat-to-beat related, mainly vagally modulated behavior is not exactly represented in CTG. However, a set of CTG-specific HRV indices that are mainly comparable to established electrophysiological HRV parameters obtained by magnetocardiography or electrocardiography provided almost similar predictive value for fetal maturational age and were helpful in characterizing FGR. These results require validation in the monitoring of further fetal developmental disturbances. We recommend a corresponding extension of CTG methodology.
Collapse
Affiliation(s)
- Dirk Hoyer
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Jena 07747, Germany. D H and U S equally contributed. Conception, data analysis and writing by D H, U S, A S. Data acquisition (Jena) by A S, A P, L V and others of the Jena research team of fetal autonomic maturation. Data acquisition (Porto) by C A C. Methods for (Porto) data acquisition by J B and D A C. Data acquisition (Munich) by S M L. Scientific discussion and final review of the manuscript by D H, U S, A S, J B, H G, D A C and S M L. Apart D H and U S, the order of the authors follows the appearance of their data sets in the manuscript
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Cahill LS, Stortz G, Chandran AR, Milligan N, Shinar S, Whitehead CL, Hobson SR, Millard S, Macgowan CK, Kingdom JC, Sled JG, Baschat AA. Determination of fetal heart rate short-term variation from umbilical artery Doppler waveforms. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:70-74. [PMID: 33030756 PMCID: PMC7779755 DOI: 10.1002/uog.23145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To evaluate the feasibility of using umbilical artery (UA) Doppler waveforms to measure fetal heart rate (FHR) short-term variation (STV) across gestation. METHODS This was a prospective longitudinal study, conducted at two study sites, of 195 pregnancies considered low risk. Pulsed-wave Doppler of the UAs was performed at 4-weekly intervals, between 14 and 40 weeks of gestation, using a standardized imaging protocol. Up to 12 consecutive UA Doppler waveforms were analyzed using offline processing software. FHR STV was calculated using average R-R intervals extracted from the waveforms and baseline corrected for FHR. RESULTS Baseline-corrected FHR STV increased significantly with gestational age (conditional R2 = 0.37; P < 0.0001) and was correlated inversely with FHR (conditional R2 = 0.54; P < 0.0001). The STV ranged (median (interquartile range)) from 3.5 (2.9-4.1) ms at 14-20 weeks' gestation to 6.3 (4.8-7.7) ms at 34-40 weeks' gestation. The change in heart rate STV did not differ between study sites or individual sonographers. CONCLUSIONS UA Doppler waveforms offer a robust and feasible method to derive STV of the FHR. It should be emphasized that the UA Doppler-derived STV is not interchangeable with measurements derived with computerized cardiotocography. Accordingly, further investigations are needed to validate associations with outcome, in order to determine the value of concurrent fetal cardiovascular and heart rate evaluations that are possible with the technique described here. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- Lindsay S. Cahill
- Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Chemistry, Memorial University of Newfoundland, St John’s, Newfoundland and Labrador, Canada
| | - Greg Stortz
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anjana Ravi Chandran
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Natasha Milligan
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shiri Shinar
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Clare L. Whitehead
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
- Pregnancy Research Centre, Department of Obstetrics and Gynaecology, Royal Women’s Hospital, Parkville, Australia
| | - Sebastian R. Hobson
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Sarah Millard
- Centre for Fetal Therapy, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Christopher K. Macgowan
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - John C. Kingdom
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - John G. Sled
- Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Ahmet A. Baschat
- Centre for Fetal Therapy, Johns Hopkins Medicine, Baltimore, Maryland, USA
| |
Collapse
|
15
|
Valderrama CE, Marzbanrad F, Hall-Clifford R, Rohloff P, Clifford GD. A Proxy for Detecting IUGR Based on Gestational Age Estimation in a Guatemalan Rural Population. Front Artif Intell 2020; 3:56. [PMID: 33733173 PMCID: PMC7861337 DOI: 10.3389/frai.2020.00056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 06/29/2020] [Indexed: 11/19/2022] Open
Abstract
In-utero progress of fetal development is normally assessed through manual measurements taken from ultrasound images, requiring relatively expensive equipment and well-trained personnel. Such monitoring is therefore unavailable in low- and middle-income countries (LMICs), where most of the perinatal mortality and morbidity exists. The work presented here attempts to identify a proxy for IUGR, which is a significant contributor to perinatal death in LMICs, by determining gestational age (GA) from data derived from simple-to-use, low-cost one-dimensional Doppler ultrasound (1D-DUS) and blood pressure devices. A total of 114 paired 1D-DUS recordings and maternal blood pressure recordings were selected, based on previously described signal quality measures. The average length of 1D-DUS recording was 10.43 ± 1.41 min. The min/median/max systolic and diastolic maternal blood pressures were 79/102/121 and 50.5/63.5/78.5 mmHg, respectively. GA was estimated using features derived from the 1D-DUS and maternal blood pressure using a support vector regression (SVR) approach and GA based on the last menstrual period as a reference target. A total of 50 trials of 5-fold cross-validation were performed for feature selection. The final SVR model was retrained on the training data and then tested on a held-out set comprising 28 normal weight and 25 low birth weight (LBW) newborns. The mean absolute GA error with respect to the last menstrual period was found to be 0.72 and 1.01 months for the normal and LBW newborns, respectively. The mean error in the GA estimate was shown to be negatively correlated with the birth weight. Thus, if the estimated GA is lower than the (remembered) GA calculated from last menstruation, then this could be interpreted as a potential sign of IUGR associated with LBW, and referral and intervention may be necessary. The assessment system may, therefore, have an immediate impact if coupled with suitable intervention, such as nutritional supplementation. However, a prospective clinical trial is required to show the efficacy of such a metric in the detection of IUGR and the impact of the intervention.
Collapse
Affiliation(s)
- Camilo E Valderrama
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States
| | - Faezeh Marzbanrad
- Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, VIC, Australia
| | - Rachel Hall-Clifford
- Department of Sociology, Center for the Study of Human Health, Emory University, Atlanta, GA, United States
| | - Peter Rohloff
- Wuqu' Kawoq
- Maya Health Alliance, Santiago Sacatepéquez, Guatemala.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States.,Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, United States
| |
Collapse
|
16
|
Singh J, Lanzarini E, Santosh P. Autonomic dysfunction and sudden death in patients with Rett syndrome: a systematic review. J Psychiatry Neurosci 2020; 45:150-181. [PMID: 31702122 PMCID: PMC7828978 DOI: 10.1503/jpn.190033] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rett syndrome (RTT), a debilitating neuropsychiatric disorder that begins in early childhood, is characterized by impairments in the autonomic nervous system that can lead to sudden unexpected death. This study explores the mechanisms of autonomic dysfunction to identify potential risk factors for sudden death in patients with RTT. METHODS Following the Reporting Items for Systematic Review and Meta-Analyses (PRISMA) criteria, we undertook comprehensive systematic reviews using the PubMed, Scopus, Cochrane, PsycINFO, Embase and Web of Science databases. RESULTS We identified and critically appraised 39 articles for autonomic dysfunction and 5 for sudden death that satisfied the eligibility criteria. Following thematic analysis, we identified 7 themes: breathing irregularities, abnormal spontaneous brainstem activations, heart rate variability metrics, QTc changes, vagal imbalance, fluctuation in peptides and serotonergic neurotransmission. We grouped these 7 themes into 3 final themes: (A) brainstem modulation of breathing, (B) electrical instability of the cardiovascular system and (C) neurochemical changes contributing to autonomic decline. We described key evidence relating to each theme and identified important areas that could improve the clinical management of patients with RTT. LIMITATIONS The heterogeneity of the methods used to assess autonomic function increased the difficulty of making inferences from the different studies. CONCLUSION This study identified the important mediators of autonomic dysfunction and sudden death in patients with RTT. We proposed brainstem mechanisms and emphasized risk factors that increase brainstem vulnerability. We discussed clinical management to reduce sudden death and future directions for this vulnerable population.
Collapse
Affiliation(s)
- Jatinder Singh
- From the Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK (Singh, Santosh); the Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London, and Maudsley NHS Foundation Trust, London, UK (Singh, Lanzarini, Santosh); and the Child and Adolescent Neuropsychiatry Unit, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy (Lanzarini)
| | - Evamaria Lanzarini
- From the Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK (Singh, Santosh); the Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London, and Maudsley NHS Foundation Trust, London, UK (Singh, Lanzarini, Santosh); and the Child and Adolescent Neuropsychiatry Unit, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy (Lanzarini)
| | - Paramala Santosh
- From the Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK (Singh, Santosh); the Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London, and Maudsley NHS Foundation Trust, London, UK (Singh, Lanzarini, Santosh); and the Child and Adolescent Neuropsychiatry Unit, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy (Lanzarini)
| |
Collapse
|
17
|
Mannella P, Billeci L, Giannini A, Canu A, Pancetti F, Simoncini T, Varanini M. A feasibility study on non-invasive fetal ECG to evaluate prenatal autonomic nervous system activity. Eur J Obstet Gynecol Reprod Biol 2020; 246:60-66. [PMID: 31962257 DOI: 10.1016/j.ejogrb.2020.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/07/2020] [Accepted: 01/11/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Maturity of the autonomic nervous system (ANS) is of paramount importance for fetal adaptation to extrauterine life and for early neurological development. Markers of ANS maturity, such as electrophysiological heart rate parameters, are of interest as tools to determine prenatal fetal maturity. The available technology, fetal magnetocardiography is expensive and not suitable for clinical use. Detection of fetal electrocardiographic signals using traditional ECG leads on the maternal abdomen may be brought to the bedside, but is technically challenging. Our group has recently developed an innovative system consisting of a standard ECG with external leads applied on the maternal abdomen coupled with a software that extracts the fetal heart signal from the maternal noise. OBJECTIVE To validate the use of this innovative non-invasive system to detect fetal ECG (fECG) and its ability to detect changes in electrophysiological fetal cardiac parameters associated with ANS maturation. STUDY DESIGN we recruited 50 pregnant women between 24 and 41 weeks and they received non-invasive recording of fECG. RESULTS fECG was measurable at all gestational ages. Fetal heart rate variability (RR interval) and other associated parameters, such as low and high frequency increased with gestational age, particularly up to the 31st week. CONCLUSIONS This study shows that non-invasive fECG is feasible throughout a broad range of gestational ages and allows detecting electrophysiological parameters of the fetal heart that may be used a surrogate of ANS maturity. Technological implementation of this system and its further exploitation may generate new tool to estimate fetal maturity.
Collapse
Affiliation(s)
- Paolo Mannella
- Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - Lucia Billeci
- Institute of Clinical Physiology (IFC) National Research Council (CNR), Pisa, Italy
| | - Andrea Giannini
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Alessio Canu
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Federica Pancetti
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Maurizio Varanini
- Institute of Clinical Physiology (IFC) National Research Council (CNR), Pisa, Italy
| |
Collapse
|
18
|
Mat Husin H, Schleger F, Bauer I, Fehlert E, Kiefer-Schmidt I, Weiss M, Kagan KO, Brucker S, Pauluschke-Fröhlich J, Eswaran H, Häring HU, Fritsche A, Preissl H. Maternal Weight, Weight Gain, and Metabolism are Associated with Changes in Fetal Heart Rate and Variability. Obesity (Silver Spring) 2020; 28:114-121. [PMID: 31858736 DOI: 10.1002/oby.22664] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/29/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Prepregnancy obesity and extensive weight gain can lead to diseases in the offspring later in life. The aim of this study was to evaluate the effect of anthropometric and metabolic factors on the fetal autonomic nervous system (ANS) in uncomplicated pregnancies. METHODS A total of 184 pregnant women in the second or third trimester were included, and for 104 women, maternal insulin sensitivity (ISI) was determined. Fetal heart rate (HR) and heart rate variability (HRV) were determined by magnetic recording. Associations of maternal prepregnancy BMI, weight gain, and ISI with fetal HR and HRV were evaluated by ANCOVA, partial correlation, and mediation analysis. RESULTS HR was increased and HRV decreased in fetuses of mothers with overweight or obesity in comparison to normal-weight mothers. Fetal HR was negatively correlated with maternal weight gain. Maternal prepregnancy BMI was positively correlated with fetal high frequency and was negatively correlated with low frequency and low/high frequency ratio. Maternal ISI showed a negative correlation with fetal HR. CONCLUSIONS The results show that the fetal ANS is sensitive to alterations of prepregnancy BMI, weight changes, and glucose metabolism. These findings highlight the importance of the intrauterine environment on the developing ANS and the possible programming of obesity.
Collapse
Affiliation(s)
- Haliza Mat Husin
- fMEG Center, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany
- Graduate Training Centre of Neuroscience, International Max Planck Research School, University of Tübingen, Tübingen, Germany
| | - Franziska Schleger
- fMEG Center, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich (IDM) at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Tübingen, Germany
| | - Ilena Bauer
- fMEG Center, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich (IDM) at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Tübingen, Germany
| | - Ellen Fehlert
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, University of Tübingen, Tübingen, Germany
| | - Isabelle Kiefer-Schmidt
- Department of Obstetrics and Gynecology, University Hospital, University of Tübingen, Tübingen, Germany
| | - Magdalene Weiss
- Department of Obstetrics and Gynecology, University Hospital, University of Tübingen, Tübingen, Germany
| | - Karl Oliver Kagan
- Department of Obstetrics and Gynecology, University Hospital, University of Tübingen, Tübingen, Germany
| | - Sara Brucker
- Department of Obstetrics and Gynecology, University Hospital, University of Tübingen, Tübingen, Germany
| | - Jan Pauluschke-Fröhlich
- Department of Obstetrics and Gynecology, University Hospital, University of Tübingen, Tübingen, Germany
| | - Hari Eswaran
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Hans-Ulrich Häring
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich (IDM) at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Tübingen, Germany
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, University of Tübingen, Tübingen, Germany
| | - Andreas Fritsche
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich (IDM) at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Tübingen, Germany
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, University of Tübingen, Tübingen, Germany
| | - Hubert Preissl
- fMEG Center, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich (IDM) at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Tübingen, Germany
- Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital, University of Tübingen, Tübingen, Germany
- Department of Pharmacy and Biochemistry, Interfaculty Centre for Pharmacogenomics and Pharma Research, University of Tübingen, Tübingen, Germany
- Institute for Diabetes and Obesity, Helmholtz Diabetes Centre, Helmholtz Centre Munich, German Research Centre for Environmental Health (GmbH), Neuherberg, Germany
| |
Collapse
|
19
|
Schmidt A, Witte R, Swiderski L, Zöllkau J, Schneider U, Hoyer D. Advanced automatic detection of fetal body movements from multichannel magnetocardiographic signals. Physiol Meas 2019; 40:085005. [PMID: 31426051 DOI: 10.1088/1361-6579/ab3c96] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Both heart rate (HR) monitoring and detection and description of fetal movements provide essential information of the integrity of in utero development and fetal wellbeing. Our previously described method to identify movements from multichannel magnetocardiographic (MCG) recordings lacks of reliability in some cases. This work is aimed at the improvement of fetal movement detection by means of an advanced signal processing and validation strategy. APPROACH The previously proposed methodology of fetal body movement detection from MCG recordings using single space angle (SSA), min-max amplitude (MMA) and a measure of the overall signal strength across (RSS) was extended by moving correlation coefficient (MCC). The methodology was developed with respect to the discrimination between active and quiet sleep, validated by testing its coupling with HR accelerations in a total of 137 recordings lasting 30 min from 98 fetuses aged 34-38 weeks of gestation (WGA) of normal pregnancy. MAIN RESULTS The developed algorithm improves the reliable automatic detection of fetal body movements independent of the fetal sleep states and their changes in the individual MCG recordings. In the fetuses aged 34-38 WGA 94% of 15 × 15 HR accelerations were coupled with detected movements. The visual inspection of the movement graphs of 30 fetuses aged 20-32 WGA supports the transferability of the movement detector to this age. In four subjects MCG-based movement detection and maternal report on percepted fetal movements were consistent. SIGNIFICANCE The presented methodology allows the parallel automatic acquisition of precise fetal heart rate variability (HRV) indices based on subsequent beat intervals and of fetal body movements from MCG recordings during late 2nd and 3rd trimester. Potential advantages of parallel monitoring of fetal HRV and movements using MCG compared to established ultrasound technology should be investigated in subsequent studies with respect to the identification of fetuses at risk.
Collapse
Affiliation(s)
- A Schmidt
- Hans Berger Department of Neurology, Biomagnetic Center, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | | | | | | | | | | |
Collapse
|
20
|
Esposito FG, Tagliaferri S, Giudicepietro A, Giuliano N, Maruotti GM, Saccone G, Signorini MG, Magenes G, Campanile M, Zullo F. Fetal heart rate monitoring and neonatal outcome in a population of early- and late-onset intrauterine growth restriction. J Obstet Gynaecol Res 2019; 45:1343-1351. [PMID: 31099119 DOI: 10.1111/jog.13981] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/06/2019] [Indexed: 11/29/2022]
Abstract
AIM The early-onset intrauterine growth restriction (IUGR) is associated with severe placental insufficiency and Doppler abnormalities. The late-onset IUGR is associated with mild placental insufficiency and normal Doppler velocimetry. The computerized cardiotocographic (cCTG) monitoring is used to evaluate the fetal well-being in pregnancies complicated by IUGR. Our aim was to investigate the cardiotocographic characteristics of IUGR fetuses and to identify every cCTG difference between Healthy and IUGR fetuses. METHODS Four hundred thirty pregnant women were enrolled starting from the 28th week of gestation until the time of delivery: 200 healthy and 230 IUGR fetuses. Fetal heart rate (FHR) baseline (FHR), short-term variability (STV), long-term irregularity (LTI), delta, interval index (II), approximate entropy (ApEn), high frequency (HF), low frequency (LF), movement frequency (MF), LF/(HF + MF) ratio (LF/(HF + MF)) and number of decelerations were examined. Newborn baby data were also collected. RESULTS The parameters of short- and medium-term variability discriminate between IUGR and healthy fetuses before 36 weeks including FHR, STV, LTI and delta discriminate between each subgroup of IUGR were compared to each one of the other two (P < 0.05). CONCLUSION cCTG is a useful tool for the evaluation of chronic hypoxemia, which causes a delay in the maturation of all components of the autonomic and central nervous system. However, cCTG requires integration with fetal ultrasound and Doppler vessels evaluation to improve the ability to predict the neonatal outcome.
Collapse
Affiliation(s)
- Francesca G Esposito
- Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples, Italy
| | - Salvatore Tagliaferri
- Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples, Italy
| | - Antonia Giudicepietro
- Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples, Italy
| | - Natascia Giuliano
- Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples, Italy
| | - Giuseppe M Maruotti
- Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples, Italy
| | - Gabriele Saccone
- Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples, Italy
| | - Maria G Signorini
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico of Milan, Milan, Italy
| | - Giovanni Magenes
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Marta Campanile
- Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples, Italy
| | - Fulvio Zullo
- Department of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University, Naples, Italy
| |
Collapse
|
21
|
Influence of maternal physical exercise on fetal and maternal heart rate responses. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2019. [DOI: 10.1007/s12662-019-00582-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
22
|
South AM, Shaltout HA, Washburn LK, Hendricks AS, Diz DI, Chappell MC. Fetal programming and the angiotensin-(1-7) axis: a review of the experimental and clinical data. Clin Sci (Lond) 2019; 133:55-74. [PMID: 30622158 PMCID: PMC6716381 DOI: 10.1042/cs20171550] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/20/2018] [Accepted: 12/03/2018] [Indexed: 02/07/2023]
Abstract
Hypertension is the primary risk factor for cardiovascular disease that constitutes a serious worldwide health concern and a significant healthcare burden. As the majority of hypertension has an unknown etiology, considerable research efforts in both experimental models and human cohorts has focused on the premise that alterations in the fetal and perinatal environment are key factors in the development of hypertension in children and adults. The exact mechanisms of how fetal programming events increase the risk of hypertension and cardiovascular disease are not fully elaborated; however, the focus on alterations in the biochemical components and functional aspects of the renin-angiotensin (Ang) system (RAS) has predominated, particularly activation of the Ang-converting enzyme (ACE)-Ang II-Ang type 1 receptor (AT1R) axis. The emerging view of alternative pathways within the RAS that may functionally antagonize the Ang II axis raise the possibility that programming events also target the non-classical components of the RAS as an additional mechanism contributing to the development and progression of hypertension. In the current review, we evaluate the potential role of the ACE2-Ang-(1-7)-Mas receptor (MasR) axis of the RAS in fetal programming events and cardiovascular and renal dysfunction. Specifically, the review examines the impact of fetal programming on the Ang-(1-7) axis within the circulation, kidney, and brain such that the loss of Ang-(1-7) expression or tone, contributes to the chronic dysregulation of blood pressure (BP) and cardiometabolic disease in the offspring, as well as the influence of sex on potential programming of this pathway.
Collapse
Affiliation(s)
- Andrew M South
- Department of Pediatrics, Section of Nephrology, Wake Forest School of Medicine, 526 Vine Street, Winston Salem, NC 27157, U.S.A
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, 526 Vine Street, Winston Salem, NC 27157, U.S.A
- Cardiovascular Sciences Center, Wake Forest School of Medicine, 526 Vine Street, Winston Salem, NC 27157, U.S.A
- Hypertension and Vascular Research, Wake Forest School of Medicine, 526 Vine Street, Winston Salem, NC 27157, U.S.A
| | - Hossam A Shaltout
- Cardiovascular Sciences Center, Wake Forest School of Medicine, 526 Vine Street, Winston Salem, NC 27157, U.S.A
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, 526 Vine Street, Winston Salem, NC 27157, U.S.A
- Department of Pharmacology and Toxicology, School of Pharmacy, University of Alexandria, Egypt
- Hypertension and Vascular Research, Wake Forest School of Medicine, 526 Vine Street, Winston Salem, NC 27157, U.S.A
- Department of Surgery, Wake Forest School of Medicine, 526 Vine Street, Winston Salem, NC 27157, U.S.A
| | - Lisa K Washburn
- Department of Pediatrics, Section of Nephrology, Wake Forest School of Medicine, 526 Vine Street, Winston Salem, NC 27157, U.S.A
- Cardiovascular Sciences Center, Wake Forest School of Medicine, 526 Vine Street, Winston Salem, NC 27157, U.S.A
- Hypertension and Vascular Research, Wake Forest School of Medicine, 526 Vine Street, Winston Salem, NC 27157, U.S.A
| | - Alexa S Hendricks
- Cardiovascular Sciences Center, Wake Forest School of Medicine, 526 Vine Street, Winston Salem, NC 27157, U.S.A
- Hypertension and Vascular Research, Wake Forest School of Medicine, 526 Vine Street, Winston Salem, NC 27157, U.S.A
| | - Debra I Diz
- Cardiovascular Sciences Center, Wake Forest School of Medicine, 526 Vine Street, Winston Salem, NC 27157, U.S.A
- Hypertension and Vascular Research, Wake Forest School of Medicine, 526 Vine Street, Winston Salem, NC 27157, U.S.A
- Department of Surgery, Wake Forest School of Medicine, 526 Vine Street, Winston Salem, NC 27157, U.S.A
| | - Mark C Chappell
- Cardiovascular Sciences Center, Wake Forest School of Medicine, 526 Vine Street, Winston Salem, NC 27157, U.S.A.
- Hypertension and Vascular Research, Wake Forest School of Medicine, 526 Vine Street, Winston Salem, NC 27157, U.S.A
- Department of Surgery, Wake Forest School of Medicine, 526 Vine Street, Winston Salem, NC 27157, U.S.A
| |
Collapse
|
23
|
Sletten J, Lund A, Ebbing C, Cornelissen G, Aßmus J, Kiserud T, Albrechtsen S, Kessler J. The fetal circadian rhythm in pregnancies complicated by pregestational diabetes is altered by maternal glycemic control and the morning cortisol concentration. Chronobiol Int 2019; 36:481-492. [PMID: 30621462 DOI: 10.1080/07420528.2018.1561460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Circadian rhythmicity is fundamental to human physiology, and is present even during fetal life in normal pregnancies. The impact of maternal endocrine disease on the fetal circadian rhythm is not well understood. The present study aimed to determine the fetal circadian rhythm in pregnancies complicated by pregestational diabetes mellitus (PGDM), compare it with a low-risk reference population, and identify the effects of maternal glycemic control and morning cortisol concentrations. Long-term fetal electrocardiogram recordings were made in 40 women with PGDM at 28 and 36 weeks of gestation. Two recordings were made in 18 of the women (45.0%) and one recording was made in 22 (55.0%). The mean fetal heart rate (fHR) and the fHR variation (root mean square of squared differences) were extracted in 1-min epochs, and circadian rhythmicity was detected by cosinor analysis. The study cohort was divided based on HbA1c levels and morning cortisol concentrations. Statistically, significant circadian rhythms in the fHR and the fHR variation were found in 45 (100%) and 44 (95.7%) of the 45 acceptable PGDM recordings, respectively. The rhythms were similar to those of the reference population. However, there was no statistically significant population-mean rhythm in the fHR among PGDM pregnancies at 36 weeks, indicating an increased interindividual variation. The group with higher HbA1c levels (>6.0%) had no significant population-mean fHR rhythm at 28 or 36 weeks, and no significant fHR-variation rhythm at 36 weeks. Similarly, the group with a lower morning cortisol concentration (≤8.8 µg/dl) had no significant population-mean fHR-variation rhythm at 28 and 36 weeks. These findings indicate that individual fetal rhythmicity is present in pregnancies complicated by PGDM. However, suboptimal maternal glycemic control and a lower maternal morning cortisol concentration are associated with a less-well-synchronized circadian system of the fetus.
Collapse
Affiliation(s)
- Julie Sletten
- a Department of Clinical Science , University of Bergen , Bergen , Norway
| | - Agnethe Lund
- a Department of Clinical Science , University of Bergen , Bergen , Norway.,b Department of Obstetrics and Gynecology , Haukeland University Hospital , Bergen , Norway
| | - Cathrine Ebbing
- b Department of Obstetrics and Gynecology , Haukeland University Hospital , Bergen , Norway
| | - Germaine Cornelissen
- c Department of Integrative Biology and Physiology, Halberg Chronobiology Center , University of Minnesota , Minneapolis , MN , USA
| | - Jörg Aßmus
- d Centre for Clinical Research , Haukeland University Hospital , Bergen , Norway
| | - Torvid Kiserud
- a Department of Clinical Science , University of Bergen , Bergen , Norway.,b Department of Obstetrics and Gynecology , Haukeland University Hospital , Bergen , Norway
| | - Susanne Albrechtsen
- a Department of Clinical Science , University of Bergen , Bergen , Norway.,b Department of Obstetrics and Gynecology , Haukeland University Hospital , Bergen , Norway
| | - Jörg Kessler
- a Department of Clinical Science , University of Bergen , Bergen , Norway.,b Department of Obstetrics and Gynecology , Haukeland University Hospital , Bergen , Norway
| |
Collapse
|
24
|
Shaw CJ, Allison BJ, Itani N, Botting KJ, Niu Y, Lees CC, Giussani DA. Altered autonomic control of heart rate variability in the chronically hypoxic fetus. J Physiol 2018; 596:6105-6119. [PMID: 29604064 PMCID: PMC6265555 DOI: 10.1113/jp275659] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/19/2018] [Indexed: 12/28/2022] Open
Abstract
KEY POINTS Fetal heart rate variability (FHRV) has long been recognised as a powerful predictor of fetal wellbeing, and a decrease in FHRV is associated with fetal compromise. However, the mechanisms by which FHRV is reduced in the chronically hypoxic fetus have yet to be established. The sympathetic and parasympathetic influences on heart rate mature at different rates throughout fetal life, and can be assessed by time domain and power spectral analysis of FHRV. In this study of chronically instrumented fetal sheep in late gestation, we analysed FHRV daily over a 16 day period towards term, and compared changes between fetuses of control and chronically hypoxic pregnancy. We show that FHRV in sheep is reduced by chronic hypoxia, predominantly due to dysregulation of the sympathetic control of the fetal heart rate. This presents a potential mechanism by which a reduction in indices of FHRV predicts fetuses at increased risk of neonatal morbidity and mortality in humans. Reduction in overall FHRV may therefore provide a biomarker that autonomic dysregulation of fetal heart rate control has taken place in a fetus where uteroplacental dysfunction is suspected. ABSTRACT Although fetal heart rate variability (FHRV) has long been recognised as a powerful predictor of fetal wellbeing, the mechanisms by which it is reduced in the chronically hypoxic fetus have yet to be established. In particular, the physiological mechanism underlying the reduction of short term variation (STV) in fetal compromise remains unclear. In this study, we present a longitudinal study of the development of autonomic control of FHRV, assessed by indirect indices, time domain and power spectral analysis, in normoxic and chronically hypoxic, chronically catheterised, singleton fetal sheep over the last third of gestation. We used isobaric chambers able to maintain pregnant sheep for prolonged periods in hypoxic conditions (stable fetal femoral arterial P O 2 10-12 mmHg), and a customised wireless data acquisition system to record beat-to-beat variation in the fetal heart rate. We determined in vivo longitudinal changes in overall FHRV and the sympathetic and parasympathetic contribution to FHRV in hypoxic (n = 6) and normoxic (n = 6) ovine fetuses with advancing gestational age. Normoxic fetuses show gestational age-related increases in overall indices of FHRV, and in the sympathetic nervous system contribution to FHRV (P < 0.001). Conversely, gestational age-related increases in overall FHRV were impaired by exposure to chronic hypoxia, and there was evidence of suppression of the sympathetic nervous system control of FHRV after 72 h of exposure to hypoxia (P < 0.001). This demonstrates that exposure to late gestation isolated chronic fetal hypoxia has the potential to alter the development of the autonomic nervous system control of FHRV in sheep. This presents a potential mechanism by which a reduction in indices of FHRV in human fetuses affected by uteroplacental dysfunction can predict fetuses at increased risk.
Collapse
Affiliation(s)
- C. J. Shaw
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
- Institute of Reproductive and Developmental BiologyImperial College LondonLondonUK
| | - B. J. Allison
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
| | - N. Itani
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
| | - K. J. Botting
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
- Cambridge Cardiovascular Research InitiativeAddenbrooke's HospitalCambridgeUK
| | - Y. Niu
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
- Cambridge Cardiovascular Research InitiativeAddenbrooke's HospitalCambridgeUK
| | - C. C. Lees
- Institute of Reproductive and Developmental BiologyImperial College LondonLondonUK
- Department of Obstetrics and GynaecologyUniversity Hospitals LeuvenLeuvenBelgium
| | - D. A. Giussani
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
- Cambridge Cardiovascular Research InitiativeAddenbrooke's HospitalCambridgeUK
| |
Collapse
|
25
|
Sletten J, Cornelissen G, Assmus J, Kiserud T, Albrechtsen S, Kessler J. Maternal exercise, season and sex modify the daily fetal heart rate rhythm. Acta Physiol (Oxf) 2018; 224:e13093. [PMID: 29754451 DOI: 10.1111/apha.13093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/18/2018] [Accepted: 05/03/2018] [Indexed: 12/01/2022]
Abstract
AIM The knowledge on biological rhythms is rapidly expanding. We aimed to define the longitudinal development of the daily (24-hour) fetal heart rate rhythm in an unrestricted, out-of-hospital setting and to examine the effects of maternal physical activity, season and fetal sex. METHODS We recruited 48 women with low-risk singleton pregnancies. Using a portable monitor for continuous fetal electrocardiography, fetal heart rate recordings were obtained around gestational weeks 24, 28, 32 and 36. Daily rhythms in fetal heart rate and fetal heart rate variation were detected by cosinor analysis; developmental trends were calculated by population-mean cosinor and multilevel analysis. RESULTS For the fetal heart rate and fetal heart rate variation, a significant daily rhythm was present in 122/123 (99.2%) and 116/121 (95.9%) of the individual recordings respectively. The rhythms were best described by combining cosine waves with periods of 24 and 8 hours. With increasing gestational age, the magnitude of the fetal heart rate rhythm increased, and the peak of the fetal heart rate variation rhythm shifted from a mean of 14:25 (24 weeks) to 20:52 (36 weeks). With advancing gestation, the rhythm-adjusted mean value of the fetal heart rate decreased linearly in females (P < .001) and nonlinearly in males (quadratic function, P = .001). At 32 and 36 weeks, interindividual rhythm diversity was found in male fetuses during higher maternal physical activity and during the summer season. CONCLUSION The dynamic development of the daily fetal heart rate rhythm during the second half of pregnancy is modified by fetal sex, maternal physical activity and season.
Collapse
Affiliation(s)
- J Sletten
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - G Cornelissen
- Department of Integrative Biology and Physiology, Halberg Chronobiology Center, University of Minnesota, Minneapolis, MN, USA
| | - J Assmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - T Kiserud
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - S Albrechtsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - J Kessler
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
26
|
Schneider U, Bode F, Schmidt A, Nowack S, Rudolph A, Doelcker EM, Schlattmann P, Götz T, Hoyer D. Developmental milestones of the autonomic nervous system revealed via longitudinal monitoring of fetal heart rate variability. PLoS One 2018; 13:e0200799. [PMID: 30016343 PMCID: PMC6049949 DOI: 10.1371/journal.pone.0200799] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 07/03/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Fetal heart rate variability (fHRV) of normal-to-normal (NN) beat intervals provides high-temporal resolution access to assess the functioning of the autonomic nervous system (ANS). AIM To determine critical periods of fetal autonomic maturation. The developmental pace is hypothesized to change with gestational age (GA). STUDY DESIGN Prospective longitudinal observational study. SUBJECTS 60 healthy singleton fetuses were followed up by fetal magnetocardiographic heart rate monitoring 4-11 times (median 6) during the second half of gestation. OUTCOME MEASURE FHRV parameters, accounting for differential aspects of the ANS, were studied applying linear mixed models over four predefined pregnancy segments of interest (SoI: <27; 27+0-31+0; 31+1-35+0; >35+1 weeks GA). Periods of fetal active sleep and quiescence were accounted for separately. RESULTS Skewness of the NN interval distribution VLF/LF band power ratio and complexity describe a saturation function throughout the period of interest. A decreasing LF/HF ratio and an increase in pNN5 indicate a concurrent shift in sympathovagal balance. Fluctuation amplitude and parameters of short-term variability (RMSSD, HF band) mark a second acceleration towards term. In contrast, fetal quiescence is characterized by sequential, but low-margin transformations; ascending overall variability followed by an increase of complexity and superseded by fluctuation amplitude. CONCLUSIONS An increase in sympathetic activation, connected with by a higher ability of parasympathetic modulation and baseline stabilization, is reached during the transition from the late 2nd into the early 3rd trimester. Pattern characteristics indicating fetal well-being saturate at 35 weeks GA. Pronounced fetal breathing efforts near-term mirror in fHRV as respiratory sinus arrhythmia.
Collapse
Affiliation(s)
- Uwe Schneider
- Department of Obstetrics, Division of Prenatal Diagnostics and Fetal Physiology, Jena University Hospital, Jena, Germany
- * E-mail:
| | - Franziska Bode
- Department of Obstetrics, Division of Prenatal Diagnostics and Fetal Physiology, Jena University Hospital, Jena, Germany
| | - Alexander Schmidt
- Hans Berger Clinic of Neurology, Biomagnetic Center, Jena University Hospital, Jena, Germany
| | - Samuel Nowack
- Hans Berger Clinic of Neurology, Biomagnetic Center, Jena University Hospital, Jena, Germany
| | - Anja Rudolph
- Department of Obstetrics, Division of Prenatal Diagnostics and Fetal Physiology, Jena University Hospital, Jena, Germany
| | - Eva-Maria Doelcker
- Hans Berger Clinic of Neurology, Biomagnetic Center, Jena University Hospital, Jena, Germany
- Institute of Biomedical Engineering and Informatics, Technical University, Ilmenau, Germany
| | - Peter Schlattmann
- Institute for Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Theresa Götz
- Hans Berger Clinic of Neurology, Biomagnetic Center, Jena University Hospital, Jena, Germany
- Institute for Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Dirk Hoyer
- Hans Berger Clinic of Neurology, Biomagnetic Center, Jena University Hospital, Jena, Germany
| |
Collapse
|
27
|
The influence of betamethasone on fetal heart rate variability, obtained by non-invasive fetal electrocardiogram recordings. Early Hum Dev 2018; 119:8-14. [PMID: 29505915 DOI: 10.1016/j.earlhumdev.2018.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Betamethasone is widely used to enhance fetal lung maturation in case of threatened preterm labour. Fetal heart rate variability is one of the most important parameters to assess in fetal monitoring, since it is a reliable indicator for fetal distress. AIM To describe the effect of betamethasone on fetal heart rate variability, by applying spectral analysis on non-invasive fetal electrocardiogram recordings. STUDY DESIGN Prospective cohort study. SUBJECTS Patients that require betamethasone, with a gestational age from 24 weeks onwards. OUTCOME MEASURES Fetal heart rate variability parameters on day 1, 2, and 3 after betamethasone administration are compared to a reference measurement. RESULTS Following 68 inclusions, 12 patients remained with complete series of measurements and sufficient data quality. During day 1, an increase in absolute fetal heart rate variability values was seen. During day 2, a decrease in these values was seen. All trends indicate to return to pre-medication values on day 3. Normalised high- and low-frequency power show little changes during the study period. CONCLUSIONS The changes in fetal heart rate variability following betamethasone administration show the same pattern when calculated by spectral analysis of the fetal electrocardiogram, as when calculated by cardiotocography. Since normalised spectral values show little changes, the influence of autonomic modulation seems minor.
Collapse
|
28
|
Haraldsdottir K, Watson AM, Goss KN, Beshish AG, Pegelow DF, Palta M, Tetri LH, Barton GP, Brix MD, Centanni RM, Eldridge MW. Impaired autonomic function in adolescents born preterm. Physiol Rep 2018; 6:e13620. [PMID: 29595875 PMCID: PMC5875539 DOI: 10.14814/phy2.13620] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 01/25/2018] [Indexed: 01/01/2023] Open
Abstract
Preterm birth temporarily disrupts autonomic nervous system (ANS) development, and the long-term impacts of disrupted fetal development are unclear in children. Abnormal cardiac ANS function is associated with worse health outcomes, and has been identified as a risk factor for cardiovascular disease. We used heart rate variability (HRV) in the time domain (standard deviation of RR intervals, SDRR; and root means squared of successive differences, RMSSD) and frequency domain (high frequency, HF; and low frequency, LF) at rest, as well as heart rate recovery (HRR) following maximal exercise, to assess autonomic function in adolescent children born preterm. Adolescents born preterm (less than 36 weeks gestation at birth) in 2003 and 2004 and healthy age-matched full-term controls participated. Wilcoxon Rank Sum tests were used to compare variables between control and preterm groups. Twenty-one adolescents born preterm and 20 term-born controls enrolled in the study. Preterm-born subjects had lower time-domain HRV, including SDRR (69.1 ± 33.8 vs. 110.1 ± 33.0 msec, respectively, P = 0.008) and RMSSD (58.8 ± 38.2 vs. 101.5 ± 36.2 msec, respectively, P = 0.012), with higher LF variability in preterm subjects. HRR after maximal exercise was slower in preterm-born subjects at 1 min (30 ± 12 vs. 39 ± 9 bpm, respectively, P = 0.013) and 2 min (52 ± 10 vs. 60 ± 10 bpm, respectively, P = 0.016). This study is the first report of autonomic dysfunction in adolescents born premature. Given prior association of impaired HRV with adult cardiovascular disease, additional investigations into the mechanisms of autonomic dysfunction in this population are warranted.
Collapse
Affiliation(s)
- Kristin Haraldsdottir
- Department of PediatricsUniversity of WisconsinMadisonWisconsin
- Department of KinesiologyUniversity of WisconsinMadisonWisconsin
| | - Andrew M. Watson
- Department of Orthopedics & RehabilitationUniversity of WisconsinMadisonWisconsin
| | - Kara N. Goss
- Department of PediatricsUniversity of WisconsinMadisonWisconsin
- Department of MedicineUniversity of WisconsinMadisonWisconsin
| | - Arij G. Beshish
- Department of PediatricsUniversity of WisconsinMadisonWisconsin
| | | | - Mari Palta
- Department of Biostatistics and Medical InformaticsUniversity of WisconsinMadisonWisconsin
| | - Laura H. Tetri
- Department of PediatricsUniversity of WisconsinMadisonWisconsin
| | | | - Melissa D. Brix
- Department of PediatricsUniversity of WisconsinMadisonWisconsin
| | | | - Marlowe W. Eldridge
- Department of PediatricsUniversity of WisconsinMadisonWisconsin
- Department of KinesiologyUniversity of WisconsinMadisonWisconsin
| |
Collapse
|
29
|
Romano M, Bifulco P, Ponsiglione A, Gargiulo G, Amato F, Cesarelli M. Evaluation of floatingline and foetal heart rate variability. Biomed Signal Process Control 2018. [DOI: 10.1016/j.bspc.2017.07.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
30
|
Urfer-Maurer N, Ludyga S, Stalder T, Brand S, Holsboer-Trachsler E, Gerber M, Grob A, Weber P, Lemola S. Heart rate variability and salivary cortisol in very preterm children during school age. Psychoneuroendocrinology 2018; 87:27-34. [PMID: 29035709 DOI: 10.1016/j.psyneuen.2017.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/18/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
Abstract
The autonomic nervous system (ANS) plays a major role in the human stress response and reflects physical and psychological adaptability to a changing environment. Long-term exposure to early life stressors may alter the function of the ANS. The present study examines differences in the ANS between children born very preterm and full-term as well as the association between the ANS and the hypothalamic-pituitary-adrenal (HPA) axis, the other main branch of the human stress system. Fifty-four healthy children born very preterm (<32nd gestational week) and 67 full-term children aged 7-12 years provided data for the present study. Polysomnography (PSG) assessments were obtained during a night at the children's home in lying position at rest (wake) and during different sleep stages (stage 2 sleep, slow wave sleep, rapid-eye-movement sleep). Autonomic function was assessed by use of heart rate variability, specifically low frequency power (LF), high frequency power (HF), total spectral power (Tot Pow), and the LF/HF ratio. HPA axis activity was measured using salivary cortisol the next morning at awakening, 10, 20, and 30min later. Children born very preterm had lower LF/HF ratio during wake and stage 2 sleep compared to full-term children. Moreover, higher LF, Tot Pow, and LF/HF ratio during wake, stage 2 sleep, and REM sleep were related to more post-awakening cortisol secretion. The present study provides evidence on long-term ANS alterations after very preterm birth. Moreover, findings suggest a relation between the ANS and the HPA axis and therefore support the notion of mutual feedback between the two human stress systems.
Collapse
Affiliation(s)
| | - Sebastian Ludyga
- University of Basel, Department of Sport, Exercise and Health, Sport Sciences Section, Basel, Switzerland
| | - Tobias Stalder
- University of Siegen, Clinical Psychology, Siegen, Germany
| | - Serge Brand
- University of Basel, Department of Sport, Exercise and Health, Sport Sciences Section, Basel, Switzerland; University of Basel, Psychiatric Clinics, Center for Affective, Stress, and Sleep Disorders, Basel, Switzerland; Kermanshah University of Medical Sciences (KUMS), Sleep Disorders Research Center, Kermanshah, Iran
| | - Edith Holsboer-Trachsler
- University of Basel, Psychiatric Clinics, Center for Affective, Stress, and Sleep Disorders, Basel, Switzerland
| | - Markus Gerber
- University of Basel, Department of Sport, Exercise and Health, Sport Sciences Section, Basel, Switzerland
| | - Alexander Grob
- University of Basel, Department of Psychology, Basel, Switzerland
| | - Peter Weber
- University Children's Hospital Basel, Division of Neuropediatrics and Developmental Medicine, Basel, Switzerland
| | - Sakari Lemola
- University of Warwick, Department of Psychology, University Road, CV4 7AL, United Kingdom.
| |
Collapse
|
31
|
Warmerdam GJJ, Vullings R, Van Laar JOEH, Van der Hout-Van der Jagt MB, Bergmans JWM, Schmitt L, Oei SG. Selective heart rate variability analysis to account for uterine activity during labor and improve classification of fetal distress. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:2950-2953. [PMID: 28268931 DOI: 10.1109/embc.2016.7591348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiotocography (CTG) is currently the most often used technique for detection of fetal distress. Unfortunately, CTG has a poor specificity. Recent studies suggest that, in addition to CTG, information on fetal distress can be obtained from analysis of fetal heart rate variability (HRV). However, uterine contractions can strongly influence fetal HRV. The aim of this study is therefore to investigate whether HRV analysis for detection of fetal distress can be improved by distinguishing contractions from rest periods. Our results from feature selection indicate that HRV features calculated separately during contractions or during rest periods are more informative on fetal distress than HRV features that are calculated over the entire fetal heart rate. Furthermore, classification performance improved from a geometric mean of 69.0% to 79.6% when including the contraction-dependent HRV features, in addition to HRV features calculated over the entire fetal heart rate.
Collapse
|
32
|
Garabedian C, De Jonckheere J, Butruille L, Deruelle P, Storme L, Houfflin-Debarge V. Understanding fetal physiology and second line monitoring during labor. J Gynecol Obstet Hum Reprod 2017; 46:113-117. [PMID: 28403965 DOI: 10.1016/j.jogoh.2016.11.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/04/2016] [Accepted: 11/10/2016] [Indexed: 12/31/2022]
Abstract
Cardiotocography (CTG) is a technique used to monitor intrapartum fetal condition and is one of the most common obstetric procedures. Second line methods of fetal monitoring have been developed in an attempt to reduce unnecessary interventions due to continuous cardiotocography and to better identify fetuses at risk of intrapartum asphyxia. The acid-base balance of the fetus is evaluated by fetal blood scalp samples, the modification of the myocardial oxygenation by the fetal ECG ST-segment analysis (STAN) and the autonomic nervous system by the power spectral analysis of the fetal heart variability. To correctly interpret the features observed on CTG traces or second line methods, it seems important to understand normal physiology during labor and the compensatory mechanisms of the fetus in case of hypoxemia. Therefore, the aim of this review is first to describe fetal physiology during labor and then to explain the modification of the second line monitoring during labor.
Collapse
Affiliation(s)
- C Garabedian
- EA 4489, perinatal growth and environment, university Lille, 59000 Lille, France; Department of obstetrics, Jeanne-de-Flandre hospital, CHU Lille, 59000 Lille, France.
| | - J De Jonckheere
- EA 4489, perinatal growth and environment, university Lille, 59000 Lille, France; CIC-IT 1403, Maison Régionale de la Recherche Clinique, CHU Lille, 59000 Lille, France
| | - L Butruille
- EA 4489, perinatal growth and environment, university Lille, 59000 Lille, France
| | - P Deruelle
- EA 4489, perinatal growth and environment, university Lille, 59000 Lille, France; Department of obstetrics, Jeanne-de-Flandre hospital, CHU Lille, 59000 Lille, France
| | - L Storme
- EA 4489, perinatal growth and environment, university Lille, 59000 Lille, France; Department of neonatology, Jeanne-de-Flandre hospital, CHU Lille, 59000 Lille, France
| | - V Houfflin-Debarge
- EA 4489, perinatal growth and environment, university Lille, 59000 Lille, France; Department of obstetrics, Jeanne-de-Flandre hospital, CHU Lille, 59000 Lille, France
| |
Collapse
|
33
|
Lobmaier SM, Mensing van Charante N, Ferrazzi E, Giussani DA, Shaw CJ, Müller A, Ortiz JU, Ostermayer E, Haller B, Prefumo F, Frusca T, Hecher K, Arabin B, Thilaganathan B, Papageorghiou AT, Bhide A, Martinelli P, Duvekot JJ, van Eyck J, Visser GH, Schmidt G, Ganzevoort W, Lees CC, Schneider KT, Bilardo CM, Brezinka C, Diemert A, Derks JB, Schlembach D, Todros T, Valcamonico A, Marlow N, van Wassenaer-Leemhuis A. Phase-rectified signal averaging method to predict perinatal outcome in infants with very preterm fetal growth restriction- a secondary analysis of TRUFFLE-trial. Am J Obstet Gynecol 2016; 215:630.e1-630.e7. [PMID: 27343566 DOI: 10.1016/j.ajog.2016.06.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/25/2016] [Accepted: 06/15/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Phase-rectified signal averaging, an innovative signal processing technique, can be used to investigate quasi-periodic oscillations in noisy, nonstationary signals that are obtained from fetal heart rate. Phase-rectified signal averaging is currently the best method to predict survival after myocardial infarction in adult cardiology. Application of this method to fetal medicine has established significantly better identification than with short-term variation by computerized cardiotocography of growth-restricted fetuses. OBJECTIVE The aim of this study was to determine the longitudinal progression of phase-rectified signal averaging indices in severely growth-restricted human fetuses and the prognostic accuracy of the technique in relation to perinatal and neurologic outcome. STUDY DESIGN Raw data from cardiotocography monitoring of 279 human fetuses were obtained from 8 centers that took part in the multicenter European "TRUFFLE" trial on optimal timing of delivery in fetal growth restriction. Average acceleration and deceleration capacities were calculated by phase-rectified signal averaging to establish progression from 5 days to 1 day before delivery and were compared with short-term variation progression. The receiver operating characteristic curves of average acceleration and deceleration capacities and short-term variation were calculated and compared between techniques for short- and intermediate-term outcome. RESULTS Average acceleration and deceleration capacities and short-term variation showed a progressive decrease in their diagnostic indices of fetal health from the first examination 5 days before delivery to 1 day before delivery. However, this decrease was significant 3 days before delivery for average acceleration and deceleration capacities, but 2 days before delivery for short-term variation. Compared with analysis of changes in short-term variation, analysis of (delta) average acceleration and deceleration capacities better predicted values of Apgar scores <7 and antenatal death (area under the curve for prediction of antenatal death: delta average acceleration capacity, 0.62 [confidence interval, 0.19-1.0]; delta short-term variation, 0.54 [confidence interval, 0.13-0.97]; P=.006; area under the curve for prediction Apgar <7: average deceleration capacity <24 hours before delivery, 0.64 [confidence interval, 0.52-0.76]; short-term variation <24 hours before delivery, 0.53 [confidence interval, 0.40-0.65]; P=.015). Neither phase-rectified signal averaging indices nor short-term variation showed predictive power for developmental disability at 2 years of age (Bayley developmental quotient, <95 or <85). CONCLUSION The phase-rectified signal averaging method seems to be at least as good as short-term variation to monitor progressive deterioration of severely growth-restricted fetuses. Our findings suggest that for short-term outcomes such as Apgar score, phase-rectified signal averaging indices could be an even better test than short-term variation. Overall, our findings confirm the possible value of prospective trials based on phase-rectified signal averaging indices of autonomic nervous system of severely growth-restricted fetuses.
Collapse
|
34
|
Seliger G, Stenzel A, Kowalski EM, Hoyer D, Nowack S, Seeger S, Schneider U. Evaluation of standardized, computerized Dawes/Redman heart-rate analysis based on different recording methods and in relation to fetal beat-to-beat heart rate variability. J Perinat Med 2016; 44:785-792. [PMID: 26584353 DOI: 10.1515/jpm-2015-0169] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 10/23/2015] [Indexed: 11/15/2022]
Abstract
Dawes and Redman (DR) based their definition of short-term variation (STV) on the successive differences of mean inter-beat intervals dividing 1 min of cardiotocography recordings in 16 epochs of 3.75 s each. In contrast, heart rate variability (HRV) is based on the inter-beat intervals of discrete R peaks, also referred to as normal-to-normal (NN) intervals. Despite the historical achievements of DR in providing a robust method with the equipment available at the time to encourage the widespread use and creation of large databases, one must ask whether the STV (DR) parameter is reproducible using a different method of recording, and how much temporal information is actually lost by applying the averaging algorithm sketched above. We simultaneously performed both standard Oxford cardiotocography and transabdominal fetal electrocardiography recordings in 26 patients with low-risk singletons. In addition, we revisited our database of 418 standard fetal magnetocardiographic recordings, applying the DR algorithm to the fetal NN data and compared them to standard HRV parameters. The correlation between STV (DR) from cardiotocography and fetal electrocardiography was stronger that of either with short term fHRV from NN intervals. The methodological trade-off to gain STV as a robust parameter from heart rate traces of limited temporal resolution is accompanied by a loss of temporal information that, at the moment, only fetal magnetocardiography and, to a lesser extent, fetal electrocardiography may provide.
Collapse
|
35
|
Kapaya H, Broughton Pipkin F, Hayes-Gill B, Loughna PV. Circadian changes and sex-related differences in fetal heart rate parameters. Matern Health Neonatol Perinatol 2016; 2:9. [PMID: 27595008 PMCID: PMC5010766 DOI: 10.1186/s40748-016-0037-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous researchers have studied circadian changes in the fetal heart rate (FHR) on small sample sizes and in a strictly controlled environment. This study was undertaken to investigate these changes during the late second and third trimesters, using a portable fetal electrocardiogram recording device (Monica AN24) in pregnant women in home and hospital environments with unrestricted mobility. METHODS This was a prospective cohort study of 54 pregnant women with uncomplicated singleton pregnancies between 25 and 40 weeks gestation. FHR recordings were made up to 16 h at home or in the hospital setting in the United Kingdom. FHR data over 90 min periods were averaged and the day (7:00 am-11:00 pm) and night (11:00 pm-7:00 am) data from the same individual were compared. Data were examined for evidence of sex-related differences. RESULTS During the night, there was a significant reduction in basal heart rate (bFHR) and a significant increase in short term variation (STV) and long term variation (LTV) (P < 0.05). Basal FHR decreased (P < 0.002), whereas LTV increased (P = 0.014) with advancing gestation. Male fetuses showed greater day: night variation than females regardless of gestation (P = 0.014). There was a higher bFHR in fetuses monitored during the day in hospital (P = 0.04). CONCLUSION This study demonstrates that there are sex-, environment and time-related differences in the FHR parameters measured. These differences may need to be considered taken when interpreting FHR data.
Collapse
Affiliation(s)
- Habiba Kapaya
- Department of Oncology and Metabolism, Academic Unit of Reproductive & Developmental Medicine, 4th Floor Jessop Wing, Tree Root Walk, Sheffield, S102SF UK
| | - Fiona Broughton Pipkin
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, NG7 2RD UK
| | - Barrie Hayes-Gill
- Electrical Systems and Optics Research Division, University of Nottingham, University Park, Nottingham, NG7 2RD UK
| | - Pamela V Loughna
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, NG7 2RD UK
| |
Collapse
|
36
|
Romano M, Iuppariello L, Ponsiglione AM, Improta G, Bifulco P, Cesarelli M. Frequency and Time Domain Analysis of Foetal Heart Rate Variability with Traditional Indexes: A Critical Survey. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2016; 2016:9585431. [PMID: 27195018 PMCID: PMC4852340 DOI: 10.1155/2016/9585431] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/06/2016] [Accepted: 03/07/2016] [Indexed: 11/17/2022]
Abstract
Monitoring of foetal heart rate and its variability (FHRV) covers an important role in assessing health of foetus. Many analysis methods have been used to get quantitative measures of FHRV. FHRV has been studied in time and in frequency domain and interesting clinical results have been obtained. Nevertheless, a standardized definition of FHRV and a precise methodology to be used for its evaluation are lacking. We carried out a literature overview about both frequency domain analysis (FDA) and time domain analysis (TDA). Then, by using simulated FHR signals, we defined the methodology for FDA. Further, employing more than 400 real FHR signals, we analysed some of the most common indexes, Short Term Variability for TDA and power content of the spectrum bands and sympathovagal balance for FDA, and evaluated their ranges of values, which in many cases are a novelty. Finally, we verified the relationship between these indexes and two important parameters: week of gestation, indicator of foetal growth, and foetal state, classified as active or at rest. Our results indicate that, according to literature, it is necessary to standardize the procedure for FHRV evaluation and to consider week of gestation and foetal state before FHR analysis.
Collapse
Affiliation(s)
- Maria Romano
- DMSC, University “Magna Graecia”, Catanzaro, Italy
| | | | | | - Giovanni Improta
- Department of Public Health, University of Naples “Federico II” Hospital, Naples, Italy
| | - Paolo Bifulco
- DIETI, University of Naples “Federico II”, Naples, Italy
| | | |
Collapse
|
37
|
Abstract
The impressive program of research from the DiPietro laboratory succeeds in its aim to document the ontogeny of human fetal neurobehavioral development. From studies of great depth and breadth, and wielding creative methods of assessment, DiPietro et al. open a window into the largely inaccessible developing human fetal brain. This commentary, with reference to the seminal cardiovascular studies of the Laceys, supports the measures of the fetal heart to index fetal well-being and to provide evidence of stimulus processing. A separate case is made that the DiPietro program provides unique and invaluable information for assessing the influential Developmental Origins of Health and Disease or Fetal Programming Models. The goal of these models, to predict or understand the influences of early experience or response patterns on later postnatal life, is identical to the ultimate goal of the DiPietro program. Because human fetal behavior is uncontaminated by socialization or parenting or peers, it may be the best reflection of fetal exposures. The remarkable neurobehavioral profiles generated by the DiPietro program can make a critical contribution to the Fetal Programming Model in terms of sensitive and critical periods of nervous system vulnerability and to specify gestational periods of neurobehavioral risk.
Collapse
|
38
|
Warmerdam GJJ, Vullings R, Van Laar JOEH, Van der Hout-Van der Jagt MB, Bergmans JWM, Schmitt L, Oei SG. Using uterine activity to improve fetal heart rate variability analysis for detection of asphyxia during labor. Physiol Meas 2016; 37:387-400. [PMID: 26862891 DOI: 10.1088/0967-3334/37/3/387] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
During labor, uterine contractions can cause temporary oxygen deficiency for the fetus. In case of severe and prolonged oxygen deficiency this can lead to asphyxia. The currently used technique for detection of asphyxia, cardiotocography (CTG), suffers from a low specificity. Recent studies suggest that analysis of fetal heart rate variability (HRV) in addition to CTG can provide information on fetal distress. However, interpretation of fetal HRV during labor is difficult due to the influence of uterine contractions on fetal HRV. The aim of this study is therefore to investigate whether HRV features differ during contraction and rest periods, and whether these differences can improve the detection of asphyxia. To this end, a case-control study was performed, using 14 cases with asphyxia that were matched with 14 healthy fetuses. We did not find significant differences for individual HRV features when calculated over the fetal heart rate without separating contractions and rest periods (p > 0.30 for all HRV features). Separating contractions from rest periods did result in a significant difference. In particular the ratio between HRV features calculated during and outside contractions can improve discrimination between fetuses with and without asphyxia (p < 0.04 for three out of four ratio HRV features that were studied in this paper).
Collapse
Affiliation(s)
- G J J Warmerdam
- Faculty of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
39
|
Tetschke F, Schneider U, Schleussner E, Witte OW, Hoyer D. Assessment of fetal maturation age by heart rate variability measures using random forest methodology. Comput Biol Med 2016; 70:157-162. [PMID: 26848727 DOI: 10.1016/j.compbiomed.2016.01.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 01/14/2016] [Accepted: 01/16/2016] [Indexed: 11/17/2022]
Abstract
Fetal maturation age assessment based on heart rate variability (HRV) is a predestinated tool in prenatal diagnosis. To date, almost linear maturation characteristic curves are used in univariate and multivariate models. Models using complex multivariate maturation characteristic curves are pending. To address this problem, we use Random Forest (RF) to assess fetal maturation age and compare RF with linear, multivariate age regression. We include previously developed HRV indices such as traditional time and frequency domain indices and complexity indices of multiple scales. We found that fetal maturation was best assessed by complexity indices of short scales and skewness in state-dependent datasets (quiet sleep, active sleep) as well as in state-independent recordings. Additionally, increasing fluctuation amplitude contributed to the model in the active sleep state. None of the traditional linear HRV parameters contributed to the RF models. Compared to linear, multivariate regression, the mean prediction of gestational age (GA) is more accurate with RF than in linear, multivariate regression (quiet state: R(2)=0,617 vs. R(2)=0,461, active state: R(2)=0,521 vs. R(2)=0,436, state independent: R(2)=0,583 vs. R(2)=0,548). We conclude that classification and regression tree models such as RF methodology are appropriate for the evaluation of fetal maturation age. The decisive role of adjustments between different time scales of complexity may essentially extend previous analysis concepts mainly based on rhythms and univariate complexity indices. Those system characteristics may have implication for better understanding and accessibility of the maturating complex autonomic control and its disturbance.
Collapse
Affiliation(s)
- F Tetschke
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany.
| | - U Schneider
- Department of Obstetrics, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - E Schleussner
- Department of Obstetrics, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - O W Witte
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - D Hoyer
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| |
Collapse
|
40
|
Vairavan S, Ulusar UD, Eswaran H, Preissl H, Wilson JD, Mckelvey SS, Lowery CL, Govindan RB. A computer-aided approach to detect the fetal behavioral states using multi-sensor Magnetocardiographic recordings. Comput Biol Med 2015; 69:44-51. [PMID: 26717240 DOI: 10.1016/j.compbiomed.2015.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 11/26/2015] [Accepted: 11/28/2015] [Indexed: 11/26/2022]
Abstract
We propose a novel computational approach to automatically identify the fetal heart rate patterns (fHRPs), which are reflective of sleep/awake states. By combining these patterns with presence or absence of movements, a fetal behavioral state (fBS) was determined. The expert scores were used as the gold standard and objective thresholds for the detection procedure were obtained using Receiver Operating Characteristics (ROC) analysis. To assess the performance, intraclass correlation was computed between the proposed approach and the mutually agreed expert scores. The detected fHRPs were then associated to their corresponding fBS based on the fetal movement obtained from fetal magnetocardiogaphic (fMCG) signals. This approach may aid clinicians in objectively assessing the fBS and monitoring fetal wellbeing.
Collapse
Affiliation(s)
- S Vairavan
- Graduate Institute of Technology, University of Arkansas at Little Rock, AR, USA
| | - U D Ulusar
- Computer Engineering Department, Akdeniz University, Antalya, Turkey
| | - H Eswaran
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, AR, USA; Division of Biomedical Informatics, University of Arkansas for Medical Sciences, AR, USA
| | - H Preissl
- Division of Biomedical Informatics, University of Arkansas for Medical Sciences, AR, USA; MEG Center, University of Tubingen, Tubingen, Germany
| | - J D Wilson
- Graduate Institute of Technology, University of Arkansas at Little Rock, AR, USA
| | - S S Mckelvey
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, AR, USA
| | - C L Lowery
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, AR, USA
| | - R B Govindan
- Division of Fetal and Transitional Medicine, Fetal Medicine Institute, Children׳s National Health System, 111 Michigan Ave, NW Washington, DC 20010, USA.
| |
Collapse
|
41
|
Hoyer D, Schneider U, Kowalski EM, Schmidt A, Witte OW, Schleußner E, Hatzmann W, Grönemeyer DH, van Leeuwen P. Validation of functional fetal autonomic brain age score fABAS in 5 min short recordings. Physiol Meas 2015; 36:2369-78. [PMID: 26489779 DOI: 10.1088/0967-3334/36/11/2369] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
With the objective of evaluating the functional maturation age and developmental disturbances we have previously introduced the fetal autonomic brain age score (fABAS) using 30 min fetal magnetocardiographic recordings (fMCG, Jena). The score is based on heart rate pattern indices that are related to universal principles of developmental biology. The present work aims at the validation of the fABAS methodology on 5 min recordings from an independent database (fMCG, Bochum).We found high agreement of fABAS obtained from Jena normal fetuses (5 min subsets, n = 364) and Bochum recordings (n = 322, normal fetuses). fABAS of 48 recordings from fetuses with intra-uterine growth restriction (IUGR, Bochum) was reduced in most of the cases, a result consistent with IUGR fetuses from Jena previously reported. fABAS calculated from 5 min snapshots only partly covers the accuracy when compared to fABAS from 30 min recordings. More precise diagnosis requires longer recordings.fABAS obtained from fMCG recordings is a strong candidate for standardized assessment of functional maturation age and developmental disturbances. Even 5 min recordings seem to be valuable for screening for maturation problems.
Collapse
Affiliation(s)
- Dirk Hoyer
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, 07743, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Fyfe KL, Yiallourou SR, Wong FY, Odoi A, Walker AM, Horne RSC. The Effect of Gestational Age at Birth on Post-Term Maturation of Heart Rate Variability. Sleep 2015; 38:1635-44. [PMID: 25902805 DOI: 10.5665/sleep.5064] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 03/14/2015] [Indexed: 12/19/2022] Open
Abstract
STUDY OBJECTIVE Preterm birth delays maturation of autonomic cardiovascular control, reflected in reduced heart rate variability (HRV) in preterm compared to term infants at term-equivalent age. It has been suggested that immature cardiovascular control contributes to the increased risk for the sudden infant death syndrome (SIDS) in preterm infants. However, the effects of prone sleeping, the major SIDS risk factor, and of gestational age (GA) at birth on HRV have not been assessed in preterm infants beyond term-equivalent age. SUBJECTS AND METHODS Very preterm (n = 21; mean GA 29.4 ± 0.3 weeks), preterm (n = 14; mean GA 33.5 ± 0.3 weeks), and term (n = 17; mean GA 40.1 ± 0.3 weeks) infants were recruited and underwent daytime polysomnography at 2-4 weeks, 2-3 months, and 5-6 months post-term corrected age (CA). Infants slept both supine and prone. HRV was assessed in the low frequency (LF) and high frequency (HF) ranges. RESULTS There was no effect of prone sleeping on HRV parameters in either preterm group. In term infants LF/HF was significantly elevated in the prone position in AS at 2-4 weeks (P < 0.05). HF HRV was significantly reduced (P < 0.05) and LF/HF increased (P < 0.05) in very preterm compared to both preterm and term infants at 2-3 months CA. CONCLUSION Prone sleeping did not significantly impact on heart rate variability (HRV) in preterm infants. However, reduced maturation of high frequency HRV in very preterm infants resulted in significantly altered sympathovagal balance at 2-3 months corrected age, the age of peak sudden infant death syndrome (SIDS) risk. This may contribute to the increased risk of SIDS in infants born at earlier gestational age.
Collapse
Affiliation(s)
- Karinna L Fyfe
- The Ritchie Centre, Hudson Institute of Medical Research and Monash University, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Stephanie R Yiallourou
- The Ritchie Centre, Hudson Institute of Medical Research and Monash University, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Flora Y Wong
- The Ritchie Centre, Hudson Institute of Medical Research and Monash University, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia.,Monash Newborn, Monash Medical Centre, Melbourne, Australia
| | - Alexsandria Odoi
- The Ritchie Centre, Hudson Institute of Medical Research and Monash University, Melbourne, Australia
| | - Adrian M Walker
- The Ritchie Centre, Hudson Institute of Medical Research and Monash University, Melbourne, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Hudson Institute of Medical Research and Monash University, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| |
Collapse
|
43
|
Doret M, Spilka J, Chudáček V, Gonçalves P, Abry P. Fractal Analysis and Hurst Parameter for Intrapartum Fetal Heart Rate Variability Analysis: A Versatile Alternative to Frequency Bands and LF/HF Ratio. PLoS One 2015; 10:e0136661. [PMID: 26322889 PMCID: PMC4556442 DOI: 10.1371/journal.pone.0136661] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/06/2015] [Indexed: 11/18/2022] Open
Abstract
Background The fetal heart rate (FHR) is commonly monitored during labor to detect early fetal acidosis. FHR variability is traditionally investigated using Fourier transform, often with adult predefined frequency band powers and the corresponding LF/HF ratio. However, fetal conditions differ from adults and modify spectrum repartition along frequencies. Aims This study questions the arbitrariness definition and relevance of the frequency band splitting procedure, and thus of the calculation of the underlying LF/HF ratio, as efficient tools for characterizing intrapartum FHR variability. Study Design The last 30 minutes before delivery of the intrapartum FHR were analyzed. Subjects Case-control study. A total of 45 singletons divided into two groups based on umbilical cord arterial pH: the Index group with pH ≤ 7.05 (n = 15) and Control group with pH > 7.05 (n = 30). Outcome Measures Frequency band-based LF/HF ratio and Hurst parameter. Results This study shows that the intrapartum FHR is characterized by fractal temporal dynamics and promotes the Hurst parameter as a potential marker of fetal acidosis. This parameter preserves the intuition of a power frequency balance, while avoiding the frequency band splitting procedure and thus the arbitrary choice of a frequency separating bands. The study also shows that extending the frequency range covered by the adult-based bands to higher and lower frequencies permits the Hurst parameter to achieve better performance for identifying fetal acidosis. Conclusions The Hurst parameter provides a robust and versatile tool for quantifying FHR variability, yields better acidosis detection performance compared to the LF/HF ratio, and avoids arbitrariness in spectral band splitting and definitions.
Collapse
Affiliation(s)
- Muriel Doret
- Department of Obstetrics and Gynaecology, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Bron, France
- * E-mail:
| | - Jiří Spilka
- Physics Department, CNRS, ENS Lyon, France
- Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
| | - Václav Chudáček
- Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
| | | | | |
Collapse
|
44
|
Karmakar C, Kimura Y, Palaniswami M, Khandoker A. Analysis of fetal heart rate asymmetry before and after 35 weeks of gestation. Biomed Signal Process Control 2015. [DOI: 10.1016/j.bspc.2015.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
45
|
Gierałtowski J, Hoyer D, Schneider U, Żebrowski JJ. Formation of functional associations across time scales in the fetal autonomic control system--a multifractal analysis. Auton Neurosci 2015; 190:33-9. [PMID: 25892613 DOI: 10.1016/j.autneu.2015.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 02/09/2015] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
Abstract
During fetal development, different control systems mediated by the autonomic nervous system form functional connections over a wide range of time scales. Using multiscale multifractal analysis (MMA) of fetal heart rate variability (HRV), we describe fundamental relationships in the developing scale-wide adjustments within fetal behavior states as well as across state changes. MMA yields the local Hurst exponent surface h(q,s) with q as the multifractal parameter and s as the scale. In 30-minute recordings of healthy fetuses between 24 and 36weeks of gestation (n=25 in quiet sleep, n=29 in active sleep, n=30 changing sleep state) we investigated the dependency of h(q,s) on gestation age. In univariate models, we found a decreasing persistence for short scales and small amplitudes in the quiet (s1=39, q1=-0.7, R(2)=0.52) and in the active (s1=69, q1=-1.4, R(2)=0.23) sleep in contrast to an increasing persistency for long scales and large amplitudes (s1=147, q1=2.4, R(2)=0.29) in the mixed state. Bivariate models (additional scales considered) presented increased coefficients of determination R(2)=0.56, 0.4, and 0.43, respectively. Persistency increasing with age in connection with the sleep state changes (independent of the age related short range dependencies within the separate homogeneous sleep states) is reported here for the first time. The MMA indices obtained for the fetal HRV represent characteristics of the maturating scale-wide cardiovascular control in the context of the evolving sleep state dynamics, which have so far not been considered. They should be incorporated in the search for HRV indices for prenatal diagnosis of developmental disorders and risk assessment.
Collapse
Affiliation(s)
- J Gierałtowski
- Faculty of Physics, Warsaw University of Technology, Warsaw, Poland.
| | - D Hoyer
- Jena University Hospital, Biomagnetic Center, Hans Berger Department of Neurology, Friedrich Schiller University, Jena, Germany
| | - U Schneider
- Jena University Hospital, Department of Obstetrics, Friedrich Schiller University, Jena, Germany
| | - J J Żebrowski
- Faculty of Physics, Warsaw University of Technology, Warsaw, Poland
| |
Collapse
|
46
|
Brändle J, Preissl H, Draganova R, Ortiz E, Kagan KO, Abele H, Brucker SY, Kiefer-Schmidt I. Heart rate variability parameters and fetal movement complement fetal behavioral states detection via magnetography to monitor neurovegetative development. Front Hum Neurosci 2015; 9:147. [PMID: 25904855 PMCID: PMC4388008 DOI: 10.3389/fnhum.2015.00147] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 03/02/2015] [Indexed: 11/13/2022] Open
Abstract
Fetal behavioral states are defined by fetal movement and heart rate variability (HRV). At 32 weeks of gestational age (GA) the distinction of four fetal behavioral states represented by combinations of quiet or active sleep or awakeness is possible. Prior to 32 weeks, only periods of fetal activity and quiesence can be distinguished. The increasing synchronization of fetal movement and HRV reflects the development of the autonomic nervous system (ANS) control. Fetal magnetocardiography (fMCG) detects fetal heart activity at high temporal resolution, enabling the calculation of HRV parameters. This study combined the criteria of fetal movement with the HRV analysis to complete the criteria for fetal state detection. HRV parameters were calculated including the standard deviation of the normal-to-normal R–R interval (SDNN), the mean square of successive differences of the R–R intervals (RMSSD, SDNN/RMSSD ratio, and permutation entropy (PE) to gain information about the developing influence of the ANS within each fetal state. In this study, 55 magnetocardiograms from healthy fetuses of 24–41 weeks’ GA were recorded for up to 45 min using a fetal biomagnetometer. Fetal states were classified based on HRV and movement detection. HRV parameters were calculated for each state. Before GA 32 weeks, 58.4% quiescence and 41.6% activity cycles were observed. Later, 24% quiet sleep state (1F), 65.4% active sleep state (2F), and 10.6% active awake state (4F) were observed. SDNN increased over gestation. Changes of HRV parameters between the fetal behavioral states, especially between 1F and 4F, were statistically significant. Increasing fetal activity was confirmed by a decrease in PE complexity measures. The fHRV parameters support the differentiation between states and indicate the development of autonomous nervous control of heart rate function.
Collapse
Affiliation(s)
- Johanna Brändle
- University Women's Hospital and Research Institute for Women's Health, University of Tuebingen Tuebingen, Germany ; fMEG Center, University of Tuebingen Tuebingen, Germany ; Department of Obstetrics and Gynecology, University of Tuebingen Tuebingen, Germany
| | | | | | - Erick Ortiz
- fMEG Center, University of Tuebingen Tuebingen, Germany
| | - Karl O Kagan
- Department of Obstetrics and Gynecology, University of Tuebingen Tuebingen, Germany
| | - Harald Abele
- Department of Obstetrics and Gynecology, University of Tuebingen Tuebingen, Germany
| | - Sara Y Brucker
- University Women's Hospital and Research Institute for Women's Health, University of Tuebingen Tuebingen, Germany ; Department of Obstetrics and Gynecology, University of Tuebingen Tuebingen, Germany
| | - Isabelle Kiefer-Schmidt
- University Women's Hospital and Research Institute for Women's Health, University of Tuebingen Tuebingen, Germany ; fMEG Center, University of Tuebingen Tuebingen, Germany ; Department of Obstetrics and Gynecology, University of Tuebingen Tuebingen, Germany
| |
Collapse
|
47
|
Abstract
AIM OF THE STUDY Analyzing velocimetric (umbilical artery, UA; ductus venosus, DV; middle cerebral artery, MCA) and computerized cardiotocographic (cCTG) (fetal heart rate, FHR; short term variability, STV; approximate entropy, ApEn) parameters in intrauterine growth restriction, IUGR, in order to detect early signs of fetal compromise. POPULATION STUDY: 375 pregnant women assisted from the 28th week of amenorrhea to delivery and monitored through cCTG and Doppler ultrasound investigation. The patients were divided into three groups according to the age of gestation at the time of delivery, before the 34th week, from 34th to 37th week, and after the 37th week. Data were analyzed in relation to the days before delivery and according to the physiology or pathology of velocimetry. Statistical analysis was performed through the t-test, chi-square test, and Pearson correlation test (P < 0.05). Our results evidenced an earlier alteration of UA, DV, and MCA. The analysis between cCTG and velocimetric parameters (the last distinguished into physiological and pathological values) suggests a possible relation between cCTG alterations and Doppler ones. The present study emphasizes the need for an antenatal testing in IUGR fetuses using multiple surveillance modalities to enhance prediction of neonatal outcome.
Collapse
|
48
|
Hoyer D, Kowalski EM, Schmidt A, Tetschke F, Nowack S, Rudolph A, Wallwitz U, Kynass I, Bode F, Tegtmeyer J, Kumm K, Moraru L, Götz T, Haueisen J, Witte OW, Schleußner E, Schneider U. Fetal autonomic brain age scores, segmented heart rate variability analysis, and traditional short term variability. Front Hum Neurosci 2014; 8:948. [PMID: 25505399 PMCID: PMC4243554 DOI: 10.3389/fnhum.2014.00948] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 11/07/2014] [Indexed: 11/13/2022] Open
Abstract
Disturbances of fetal autonomic brain development can be evaluated from fetal heart rate patterns (HRP) reflecting the activity of the autonomic nervous system. Although HRP analysis from cardiotocographic (CTG) recordings is established for fetal surveillance, temporal resolution is low. Fetal magnetocardiography (MCG), however, provides stable continuous recordings at a higher temporal resolution combined with a more precise heart rate variability (HRV) analysis. A direct comparison of CTG and MCG based HRV analysis is pending. The aims of the present study are: (i) to compare the fetal maturation age predicting value of the MCG based fetal Autonomic Brain Age Score (fABAS) approach with that of CTG based Dawes-Redman methodology; and (ii) to elaborate fABAS methodology by segmentation according to fetal behavioral states and HRP. We investigated MCG recordings from 418 normal fetuses, aged between 21 and 40 weeks of gestation. In linear regression models we obtained an age predicting value of CTG compatible short term variability (STV) of R (2) = 0.200 (coefficient of determination) in contrast to MCG/fABAS related multivariate models with R (2) = 0.648 in 30 min recordings, R (2) = 0.610 in active sleep segments of 10 min, and R (2) = 0.626 in quiet sleep segments of 10 min. Additionally segmented analysis under particular exclusion of accelerations (AC) and decelerations (DC) in quiet sleep resulted in a novel multivariate model with R (2) = 0.706. According to our results, fMCG based fABAS may provide a promising tool for the estimation of fetal autonomic brain age. Beside other traditional and novel HRV indices as possible indicators of developmental disturbances, the establishment of a fABAS score normogram may represent a specific reference. The present results are intended to contribute to further exploration and validation using independent data sets and multicenter research structures.
Collapse
Affiliation(s)
- Dirk Hoyer
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Eva-Maria Kowalski
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany ; Institute of Biomedical Engineering and Informatics, Ilmenau University of Technology Ilmenau, Germany
| | - Alexander Schmidt
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Florian Tetschke
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Samuel Nowack
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Anja Rudolph
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany ; Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Ulrike Wallwitz
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany ; Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Isabelle Kynass
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany ; Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Franziska Bode
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany ; Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Janine Tegtmeyer
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany ; Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Kathrin Kumm
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany ; Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Liviu Moraru
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Theresa Götz
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Jens Haueisen
- Institute of Biomedical Engineering and Informatics, Ilmenau University of Technology Ilmenau, Germany
| | - Otto W Witte
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Ekkehard Schleußner
- Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Uwe Schneider
- Department of Obstetrics, Jena University Hospital, Friedrich Schiller University Jena, Germany
| |
Collapse
|
49
|
Schmidt A, Schneider U, Witte OW, Schleußner E, Hoyer D. Developing fetal motor-cardiovascular coordination analyzed from multi-channel magnetocardiography. Physiol Meas 2014; 35:1943-59. [PMID: 25229562 DOI: 10.1088/0967-3334/35/10/1943] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Fetal movements (FM) related heart rate accelerations (AC) are an important maturation criterion. Since Doppler-based time resolution is not sufficient for accompanying heart rate variability analysis, the work is aimed at a comprehensive FM-AC analysis using magnetocardiographic recordings from fetuses during sleep.We identify FM and AC by independent component analysis and automatic recognition algorithms. We investigate associations between FM and AC of different magnitude by means of event coincidence and time series cross-correlation over the maturation period of 21-40 weeks of gestation (WGA).FM related AC appear with increasing AC magnitude and WGA. Vice versa, AC related FM appear independent of WGA, but more frequently with increasing AC amplitude. The FM-AC correlation exists already at 21 WGA and further increases with WGA while the variability of its time delay decreases. Hence, FM and AC are clearly associated over the whole investigated maturation period. The increase of FM related AC runs parallel to the increasing AC magnitude.The MCG methodology was confirmed and results from previous Doppler-based analyses reproduced. Hence, MCG recordings allow the collective analysis of heart rate variability based maturation indices and FM related AC. This synergism may improve the diagnosis of fetal developmental disorders.
Collapse
Affiliation(s)
- A Schmidt
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | | | | | | | | |
Collapse
|
50
|
Van Leeuwen P, Cysarz D, Edelhäuser F, Grönemeyer D. Heart rate variability in the individual fetus. Auton Neurosci 2013; 178:24-8. [DOI: 10.1016/j.autneu.2013.01.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 12/13/2012] [Accepted: 01/04/2013] [Indexed: 10/27/2022]
|