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Wurm D, Ewert P, Fierlinger P, Wakai RT, Wallner V, Wunderl L, Wacker-Gußmann A. A Small Scale Optically Pumped Fetal Magnetocardiography System. J Clin Med 2023; 12:jcm12103380. [PMID: 37240486 DOI: 10.3390/jcm12103380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/26/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Fetal magnetocardiography (fMCG) is considered the best technique for diagnosis of fetal arrhythmia. It is superior to more widely used methods such as fetal, fetal electrocardiography, and cardiotocography for evaluation of fetal rhythm. The combination of fMCG and fetal echocardiography can provide a more comprehensive evaluation of fetal cardiac rhythm and function than is currently possible. In this study, we demonstrate a practical fMCG system based on optically pumped magnetometers (OPMs). METHODS Seven pregnant women with uncomplicated pregnancies underwent fMCG at 26-36 weeks' gestation. The recordings were made using an OPM-based fMCG system and a person-sized magnetic shield. The shield is much smaller than a shielded room and provides easy access with a large opening that allows the pregnant woman to lie comfortably in a prone position. RESULTS The data show no significant loss of quality compared to data acquired in a shielded room. Measurements of standard cardiac time intervals yielded the following results: PR = 104 ± 6 ms, QRS = 52.6 ± 1.5 ms, and QTc = 387 ± 19 ms. These results are compatible with those from prior studies performed using superconducting quantum interference device (SQUID) fMCG systems. CONCLUSIONS To our knowledge, this is the first European fMCG device with OPM technology commissioned for basic research in a pediatric cardiology unit. We demonstrated a patient-friendly, comfortable, and open fMCG system. The data yielded consistent cardiac intervals, measured from time-averaged waveforms, compatible with published SQUID and OPM data. This is an important step toward making the method widely accessible.
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Affiliation(s)
- David Wurm
- Chair E66, School of Natural Sciences, Technical University of Munich, 80636 Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center, 80636 Munich, Germany
| | - Peter Fierlinger
- Chair E66, School of Natural Sciences, Technical University of Munich, 80636 Munich, Germany
| | - Ronald T Wakai
- Department of Medical Physics, University of Wisconsin Madison, Madison, WI 53706, USA
| | - Verena Wallner
- Chair E66, School of Natural Sciences, Technical University of Munich, 80636 Munich, Germany
| | - Lena Wunderl
- Chair E66, School of Natural Sciences, Technical University of Munich, 80636 Munich, Germany
| | - Annette Wacker-Gußmann
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center, 80636 Munich, Germany
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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.
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Semeia L, Sippel K, Moser J, Preissl H. Evaluation of parameters for fetal behavioural state classification. Sci Rep 2022; 12:3410. [PMID: 35233073 PMCID: PMC8888564 DOI: 10.1038/s41598-022-07476-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/07/2022] [Indexed: 11/09/2022] Open
Abstract
Fetal behavioural states (fBS) describe periods of fetal wakefulness and sleep and are commonly defined by features such as body and eye movements and heart rate. Automatic state detection through algorithms relies on different parameters and thresholds derived from both the heart rate variability (HRV) and the actogram, which are highly dependent on the specific datasets and are prone to artefacts. Furthermore, the development of the fetal states is dynamic over the gestational period and the evaluation usually only separated into early and late gestation (before and after 32 weeks). In the current work, fBS detection was consistent between the classification algorithm and visual inspection in 87 fetal magnetocardiographic data segments between 27 and 39 weeks of gestational age. To identify how automated fBS detection could be improved, we first identified commonly used parameters for fBS classification in both the HRV and the actogram, and investigated their distribution across the different fBS. Then, we calculated a receiver operating characteristics (ROC) curve to determine the performance of each parameter in the fBS classification. Finally, we investigated the development of parameters over gestation through linear regression. As a result, the parameters derived from the HRV have a higher classification accuracy compared to those derived from the body movement as defined by the actogram. However, the overlapping distributions of several parameters across states limit a clear separation of states based on these parameters. The changes over gestation of the HRV parameters reflect the maturation of the fetal autonomic nervous system. Given the higher classification accuracy of the HRV in comparison to the actogram, we suggest to focus further research on the HRV. Furthermore, we propose to develop probabilistic fBS classification approaches to improve classification in less prototypical datasets.
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Affiliation(s)
- Lorenzo Semeia
- IDM/fMEG Center of the Helmholtz Center Munich at the University of Tübingen, University of Tübingen, German Center for Diabetes Research (DZD), Otfried-Müller-Str. 47, 72076, Tübingen, Germany. .,Graduate Training Centre of Neuroscience, International Max Planck Research School, University of Tübingen, Tübingen, Germany.
| | - Katrin Sippel
- IDM/fMEG Center of the Helmholtz Center Munich at the University of Tübingen, University of Tübingen, German Center for Diabetes Research (DZD), Otfried-Müller-Str. 47, 72076, Tübingen, Germany.,Department of Internal Medicine IV, University Hospital of Tübingen, Tübingen, Germany
| | - Julia Moser
- IDM/fMEG Center of the Helmholtz Center Munich at the University of Tübingen, University of Tübingen, German Center for Diabetes Research (DZD), Otfried-Müller-Str. 47, 72076, Tübingen, Germany.,Graduate Training Centre of Neuroscience, International Max Planck Research School, University of Tübingen, Tübingen, Germany
| | - Hubert Preissl
- IDM/fMEG Center of the Helmholtz Center Munich at the University of Tübingen, University of Tübingen, German Center for Diabetes Research (DZD), Otfried-Müller-Str. 47, 72076, Tübingen, Germany.,Department of Internal Medicine IV, University Hospital of Tübingen, Tübingen, Germany.,Department of Pharmacy and Biochemistry, Interfaculty Centre for Pharmacogenomics and Pharma Research, University of Tübingen, Tübingen, Germany
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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.
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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
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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.
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Ribeiro M, Monteiro-Santos J, Castro L, Antunes L, Costa-Santos C, Teixeira A, Henriques TS. Non-linear Methods Predominant in Fetal Heart Rate Analysis: A Systematic Review. Front Med (Lausanne) 2021; 8:661226. [PMID: 34917624 PMCID: PMC8669823 DOI: 10.3389/fmed.2021.661226] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 11/04/2021] [Indexed: 12/19/2022] Open
Abstract
The analysis of fetal heart rate variability has served as a scientific and diagnostic tool to quantify cardiac activity fluctuations, being good indicators of fetal well-being. Many mathematical analyses were proposed to evaluate fetal heart rate variability. We focused on non-linear analysis based on concepts of chaos, fractality, and complexity: entropies, compression, fractal analysis, and wavelets. These methods have been successfully applied in the signal processing phase and increase knowledge about cardiovascular dynamics in healthy and pathological fetuses. This review summarizes those methods and investigates how non-linear measures are related to each paper's research objectives. Of the 388 articles obtained in the PubMed/Medline database and of the 421 articles in the Web of Science database, 270 articles were included in the review after all exclusion criteria were applied. While approximate entropy is the most used method in classification papers, in signal processing, the most used non-linear method was Daubechies wavelets. The top five primary research objectives covered by the selected papers were detection of signal processing, hypoxia, maturation or gestational age, intrauterine growth restriction, and fetal distress. This review shows that non-linear indices can be used to assess numerous prenatal conditions. However, they are not yet applied in clinical practice due to some critical concerns. Some studies show that the combination of several linear and non-linear indices would be ideal for improving the analysis of the fetus's well-being. Future studies should narrow the research question so a meta-analysis could be performed, probing the indices' performance.
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Affiliation(s)
- Maria Ribeiro
- Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Computer Science Department, Faculty of Sciences, University of Porto, Porto, Portugal
| | - João Monteiro-Santos
- Centre for Health Technology and Services Research, Faculty of Medicine University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luísa Castro
- Centre for Health Technology and Services Research, Faculty of Medicine University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,School of Health of Polytechnic of Porto, Porto, Portugal
| | - Luís Antunes
- Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Computer Science Department, Faculty of Sciences, University of Porto, Porto, Portugal
| | - Cristina Costa-Santos
- Centre for Health Technology and Services Research, Faculty of Medicine University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Andreia Teixeira
- Centre for Health Technology and Services Research, Faculty of Medicine University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.,Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
| | - Teresa S Henriques
- Centre for Health Technology and Services Research, Faculty of Medicine University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
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Cerritelli F, Frasch MG, Antonelli MC, Viglione C, Vecchi S, Chiera M, Manzotti A. A Review on the Vagus Nerve and Autonomic Nervous System During Fetal Development: Searching for Critical Windows. Front Neurosci 2021; 15:721605. [PMID: 34616274 PMCID: PMC8488382 DOI: 10.3389/fnins.2021.721605] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/19/2021] [Indexed: 12/17/2022] Open
Abstract
The autonomic nervous system (ANS) is one of the main biological systems that regulates the body's physiology. Autonomic nervous system regulatory capacity begins before birth as the sympathetic and parasympathetic activity contributes significantly to the fetus' development. In particular, several studies have shown how vagus nerve is involved in many vital processes during fetal, perinatal, and postnatal life: from the regulation of inflammation through the anti-inflammatory cholinergic pathway, which may affect the functioning of each organ, to the production of hormones involved in bioenergetic metabolism. In addition, the vagus nerve has been recognized as the primary afferent pathway capable of transmitting information to the brain from every organ of the body. Therefore, this hypothesis paper aims to review the development of ANS during fetal and perinatal life, focusing particularly on the vagus nerve, to identify possible "critical windows" that could impact its maturation. These "critical windows" could help clinicians know when to monitor fetuses to effectively assess the developmental status of both ANS and specifically the vagus nerve. In addition, this paper will focus on which factors-i.e., fetal characteristics and behaviors, maternal lifestyle and pathologies, placental health and dysfunction, labor, incubator conditions, and drug exposure-may have an impact on the development of the vagus during the above-mentioned "critical window" and how. This analysis could help clinicians and stakeholders define precise guidelines for improving the management of fetuses and newborns, particularly to reduce the potential adverse environmental impacts on ANS development that may lead to persistent long-term consequences. Since the development of ANS and the vagus influence have been shown to be reflected in cardiac variability, this paper will rely in particular on studies using fetal heart rate variability (fHRV) to monitor the continued growth and health of both animal and human fetuses. In fact, fHRV is a non-invasive marker whose changes have been associated with ANS development, vagal modulation, systemic and neurological inflammatory reactions, and even fetal distress during labor.
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Affiliation(s)
- Francesco Cerritelli
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Martin G. Frasch
- Department of Obstetrics and Gynecology and Center on Human Development and Disability, University of Washington, Seattle, WA, United States
| | - Marta C. Antonelli
- Facultad de Medicina, Instituto de Biología Celular y Neurociencia “Prof. E. De Robertis”, Universidad de Buenos Aires, Buenos Aires, Argentina
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Chiara Viglione
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Stefano Vecchi
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Marco Chiera
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Andrea Manzotti
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
- Department of Pediatrics, Division of Neonatology, “V. Buzzi” Children's Hospital, Azienda Socio-Sanitaria Territoriale Fatebenefratelli Sacco, Milan, Italy
- Research Department, Istituto Osteopatia Milano, Milan, Italy
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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.
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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
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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.
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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
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10
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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.
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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
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11
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Sadeghi M, Sasangohar F, McDonald AD. Toward a Taxonomy for Analyzing the Heart Rate as a Physiological Indicator of Posttraumatic Stress Disorder: Systematic Review and Development of a Framework. JMIR Ment Health 2020; 7:e16654. [PMID: 32706710 PMCID: PMC7407264 DOI: 10.2196/16654] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/11/2020] [Accepted: 04/03/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a prevalent psychiatric condition that is associated with symptoms such as hyperarousal and overreactions. Treatments for PTSD are limited to medications and in-session therapies. Assessing the way the heart responds to PTSD has shown promise in detecting and understanding the onset of symptoms. OBJECTIVE This study aimed to extract statistical and mathematical approaches that researchers can use to analyze heart rate (HR) data to understand PTSD. METHODS A scoping literature review was conducted to extract HR models. A total of 5 databases including Medical Literature Analysis and Retrieval System Online (Medline) OVID, Medline EBSCO, Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCO, Excerpta Medica Database (Embase) Ovid, and Google Scholar were searched. Non-English language studies, as well as studies that did not analyze human data, were excluded. A total of 54 studies that met the inclusion criteria were included in this review. RESULTS We identified 4 categories of models: descriptive time-independent output, descriptive and time-dependent output, predictive and time-independent output, and predictive and time-dependent output. Descriptive and time-independent output models include analysis of variance and first-order exponential; the descriptive time-dependent output model includes a classical time series analysis and mixed regression. Predictive time-independent output models include machine learning methods and analysis of the HR-based fluctuation-dissipation method. Finally, predictive time-dependent output models include the time-variant method and nonlinear dynamic modeling. CONCLUSIONS All of the identified modeling categories have relevance in PTSD, although the modeling selection is dependent on the specific goals of the study. Descriptive models are well-founded for the inference of PTSD. However, there is a need for additional studies in this area that explore a broader set of predictive models and other factors (eg, activity level) that have not been analyzed with descriptive models.
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Affiliation(s)
- Mahnoosh Sadeghi
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Farzan Sasangohar
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
| | - Anthony D McDonald
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
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12
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Comparison of fetal heart rate variability by symbolic dynamics at the third trimester of pregnancy and low-risk parturition. Heliyon 2020; 6:e03485. [PMID: 32195385 PMCID: PMC7075801 DOI: 10.1016/j.heliyon.2020.e03485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/26/2019] [Accepted: 02/20/2020] [Indexed: 12/15/2022] Open
Abstract
Fetal heart rate variability (fHRV) is an essential source of information to monitor fetal well-being during pregnancy. This study aimed to apply a nonlinear approach, known as symbolic dynamics (SD), for comparing human fHRV in the third trimester of pregnancy during active fetal state (TT) and active labor at term (P). We performed a longitudinal, prospective, descriptive, and comparative study composed of 42 longitudinal recordings of 5-minutes of fetal heartbeat interval series. Recordings were collected from 21 low-risk, healthy, pregnant women attending the Maternal and Child Research Center (CIMIGen), Mexico City. We calculated relevant linear parameters of fHRV between TT and P stages, such as the percentage of differences between adjacent RR intervals >5 ms (PRR5, related to vagal modulations) and other SD parameters such as the percentage of no variations between three successive symbols (%0V, reflects sympathetic modulations) and the probability of low variability with a threshold of 4 ms (POLVAR4, associated with a low variability). We identified statistical differences for PRR5 between TT and P (37.13% [28.47-47.60%] vs. 28.84% [19.36-36.76%], p = 0.03), respectively. Also, for 0V% (65.66% [59.01-71.80%] vs. 71.14% [65.94-75.87%], p = 0.03) and for POLVAR4 values (0.06 [0.04-0.11] vs. 0.15 [0.09-0.24], p = 0.002), respectively. Our results indicate that during parturition, the short-term fetal fHRV is decreased, showing a decreased vagal modulations and higher adrenergic response of the heart. These autonomic modifications may result from the fetal response to the stressful inflammatory challenge of labor. We thus confirmed that the analysis of the SD applied to fHRV time series could be a potential clinical biomarker to differentiate the fetal autonomic cardiac condition at different stages of pregnancy.
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13
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Porta A, Maria BD, Cairo B, Vaini E, Bari V. Short-Term Model-Based Multiscale Complexity Analysis of Cardiac Control Provides Complementary Information to Single-Scale Approaches. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2018:4848-4851. [PMID: 30441429 DOI: 10.1109/embc.2018.8513114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The study compares a recently proposed shortterm model-based linear multiscale complexity approach to a single-scale application of the same method and to a model-free nonlinear one based on the computation of conditional entropy with the aim at assessing the complementary information. Comparison was carried out over 24 hours Holter recordings of heart period variability during daytime and nighttime in 12 healthy men (age: 34-55 years). Single-scale methods were able to detect the increased complexity of the cardiac control during nighttime. Multiscale complexity analysis showed that this increase was due to an increase of complexity in the low frequency band (from 0.04 to 0.15 Hz), while complexity in the range of frequencies typical of the respiratory rate was unmodified. Regardless of the method (i.e. linear or nonlinear) single-scale complexity indexes were uncorrelated to the multiscale ones. We conclude that short-term model-based linear multiscale complexity approach provides complementary information to single-scale methods in an application devoted to the analysis of cardiac control from 24 hours Holter recordings.
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14
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Chen K, Zhao Y, Li S, Chen L, Wang N, Zhang K, Wang Y, Zhang J. Multiscale Coupling of Uterine Electromyography and Fetal Heart Rate as a Novel Indicator of Fetal Neural Development. Front Neurol 2019; 10:760. [PMID: 31379714 PMCID: PMC6651265 DOI: 10.3389/fneur.2019.00760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/01/2019] [Indexed: 11/13/2022] Open
Abstract
Fetal nerve maturation is a dynamic process, which is reflected in fetal movement and fetal heart rate (FHR) patterns. Classical FHR variability (fHRV) indices cannot fully reflect their complex interrelationship. This study aims to provide an alternative insight for fetal neural development by using the coupling analysis of uterine electromyography (UEMG) and FHR acceleration. We investigated 39 normal pregnancies with appropriate for gestational age (AGA) and 19 high-risk pregnancies with small for gestational age (SGA) at 28-39 weeks. The UEMG and FHR were recorded simultaneously by a trans-abdominal device during the night (10 p.m.-8 a.m.). Cross-wavelet analysis was used to characterize the dynamic relationship between FHR and UEMG. Subsequently, a UEMG-FHR coupling index (UFCI) was extracted from the multiscale coupling power spectrum. We examined the gestational-age dependency of UFCI by linear/quadratic regression models, and the ability to screen for SGA using binary logistic regression. Also, the performances of classical fHRV indices, including short-term variation (STV), averaged acceleration capacity (AAC), and averaged deceleration capacity (ADC), time- and frequency- domain indices, and multiscale entropy (MSE), were compared as references on the same recordings. The results showed that UFCI provided a stronger age predicting value with R2 = 0.480, in contrast to the best value among other fHRV indices with R2 = 0.335, by univariate regression models. Also, UFCI achieved superior performance for predicting SGA with the area under the curve (AUC) of 0.88, compared with 0.79 for best performance of other fHRV indices. The present results indicate that UFCI provides new information for early detection and comprehensive interpretation of intrauterine growth restriction in prenatal diagnosis, and helps improve the screening of SGA.
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Affiliation(s)
- Kun Chen
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Yangyu Zhao
- Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Shufang Li
- Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Lian Chen
- Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Nan Wang
- Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Kai Zhang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Yan Wang
- Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Jue Zhang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.,College of Engineering, Peking University, Beijing, China
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15
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Hoyer D, Schmidt A, Gustafson KM, Lobmaier SM, Lakhno I, van Leeuwen P, Cysarz D, Preisl H, Schneider U. Heart rate variability categories of fluctuation amplitude and complexity: diagnostic markers of fetal development and its disturbances. Physiol Meas 2019; 40:064002. [PMID: 31071684 DOI: 10.1088/1361-6579/ab205f] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE In fetal diagnosis the myriad and diversity of heart rate variability (HRV) indices prevents a comparable routine evaluation of disturbances in fetal development and well-being. The work aims at the extraction of a small set of HRV key indices that could help to establish a universal, overarching tool to screen for any disturbance. APPROACH HRV indices were organized in categories of short-term (prefix s) and long-term (prefix l) amplitude fluctuations (AMP), complexity (COMP), and patterns (PATTERN) and common representatives for each category were extracted. This procedure was done with respect to the diagnostic value in the evaluation of the maturation age throughout the second and complete third trimester of pregnancy as well as to potential differences associated with maternal life-style factors (physical exercise, smoking), nutrient intervention (docosahexaenoic acid (DHA) supplementation), and complications of pregnancy (gestational diabetes mellitus (GDM), intra-uterine growth restriction (IUGR)). MAIN RESULTS We found a comprehensive minimal set that includes [lAMP: short term variation (STV), initially introduced in cardiotocography, sAMP: heart rate increase across one interbeat interval of phase rectified averaged signal - acceleration capacity (ACst1), lCOMP: scale 4 multi-scale entropy (MSE4), PATTERN: skewness] for the maturation age prediction, and partly overlapping [lAMP: STV, sAMP: ACst1, sCOMP: Lempel Ziv complexity (LZC)] for the discrimination of the deviations. SIGNIFICANCE The minimal set of category-based HRV representatives allows for a screening of fetal development and well-being. These results are an important step towards a universal and comparable diagnostic tool for the early identification of developmental disturbances. Novelty & Significance Fetal development and its disturbances have been reported to be associated with a multiplicity of HRV indices. Furthermore, these HRV indices change with maturation. We propose the abstraction of HRV categories defined by short- and long-term fluctuation amplitude, complexity, and pattern indices that cover all relevant aspects of maturational age, behavioral influences and a series of pathological disturbances. The study data are provided by multiple centers. Our approach is an important step towards the goal of a standardized diagnostic tool for early identification of fetal developmental disturbances with respect to the reduction of serious complications in the later life.
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Affiliation(s)
- Dirk Hoyer
- Hans Berger Department of Neurology, Biomagnetic Center, Jena University Hospital, Jena 07747, Germany
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16
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Schmidt A, Schukat-Talamazzini EG, Zöllkau J, Pytlik A, Leibl S, Kumm K, Bode F, Kynass I, Witte OW, Schleussner E, Schneider U, Hoyer D. Universal characteristics of evolution and development are inherent in fetal autonomic brain maturation. Auton Neurosci 2018. [DOI: 10.1016/j.autneu.2018.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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17
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A Comprehensive Evaluation of the Predictive Abilities of Fetal Electrocardiogram-Derived Parameters during Labor in Newborn Acidemia: Our Institutional Experience. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3478925. [PMID: 29888259 PMCID: PMC5985095 DOI: 10.1155/2018/3478925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/20/2018] [Accepted: 04/17/2018] [Indexed: 11/17/2022]
Abstract
This study aimed to identify cardiotocography patterns that discriminate fetal acidemia newborns by comprehensively evaluating the parameters obtained from Holter monitoring during delivery. Between June 1, 2015, and August 1, 2016, a prospective observational study of 85 patients was conducted using fetal Holter monitoring at the Beijing Obstetrics and Gynecology Hospital, Capital Medical University, China. Umbilical cord blood was sampled immediately after delivery and fetal acidemia was defined as umbilical cord arterial blood pH < 7.20. Fetal electrocardiogram- (FECG-) derived parameters, including basal fetal heart rate (BFHR), short-term variation (STV), large acceleration (LA), deceleration capacity (DC), acceleration capacity (AC), proportion of episodes of high variation (PEHV), and proportion of episodes of low variation (PELV), were compared between 16 fetuses with acidemia and 47 without. The areas under the curve (AUC) of receiver operating characteristics (ROC) were calculated. Although all the computerized parameters showed predictive values for acidemia (all AUC > 0.50), STV (AUC = 0.84, P < 0.001), DC (AUC = 0.84, P < 0.001), AC (AUC = 0.80, P < 0.001), and PELV (AUC = 0.71, P = 0.012) were more strongly associated with fetal acidemia. Our institutional experience suggests that FECG-derived parameters from Holter monitoring are beneficial in reducing the incidence of neonatal acidemia.
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18
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Porta A, Bari V, Ranuzzi G, De Maria B, Baselli G. Assessing multiscale complexity of short heart rate variability series through a model-based linear approach. CHAOS (WOODBURY, N.Y.) 2017; 27:093901. [PMID: 28964147 DOI: 10.1063/1.4999353] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We propose a multiscale complexity (MSC) method assessing irregularity in assigned frequency bands and being appropriate for analyzing the short time series. It is grounded on the identification of the coefficients of an autoregressive model, on the computation of the mean position of the poles generating the components of the power spectral density in an assigned frequency band, and on the assessment of its distance from the unit circle in the complex plane. The MSC method was tested on simulations and applied to the short heart period (HP) variability series recorded during graded head-up tilt in 17 subjects (age from 21 to 54 years, median = 28 years, 7 females) and during paced breathing protocols in 19 subjects (age from 27 to 35 years, median = 31 years, 11 females) to assess the contribution of time scales typical of the cardiac autonomic control, namely in low frequency (LF, from 0.04 to 0.15 Hz) and high frequency (HF, from 0.15 to 0.5 Hz) bands to the complexity of the cardiac regulation. The proposed MSC technique was compared to a traditional model-free multiscale method grounded on information theory, i.e., multiscale entropy (MSE). The approach suggests that the reduction of HP variability complexity observed during graded head-up tilt is due to a regularization of the HP fluctuations in LF band via a possible intervention of sympathetic control and the decrement of HP variability complexity observed during slow breathing is the result of the regularization of the HP variations in both LF and HF bands, thus implying the action of physiological mechanisms working at time scales even different from that of respiration. MSE did not distinguish experimental conditions at time scales larger than 1. Over a short time series MSC allows a more insightful association between cardiac control complexity and physiological mechanisms modulating cardiac rhythm compared to a more traditional tool such as MSE.
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Affiliation(s)
- Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Vlasta Bari
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giovanni Ranuzzi
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Beatrice De Maria
- IRCCS Istituti Clinici Scientifici Maugeri, Istituto di Milano, Milan, Italy
| | - Giuseppe Baselli
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy
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19
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Hoyer D, Żebrowski J, Cysarz D, Gonçalves H, Pytlik A, Amorim-Costa C, Bernardes J, Ayres-de-Campos D, Witte OW, Schleußner E, Stroux L, Redman C, Georgieva A, Payne S, Clifford G, Signorini MG, Magenes G, Andreotti F, Malberg H, Zaunseder S, Lakhno I, Schneider U. Monitoring fetal maturation-objectives, techniques and indices of autonomic function. Physiol Meas 2017; 38:R61-R88. [PMID: 28186000 PMCID: PMC5628752 DOI: 10.1088/1361-6579/aa5fca] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Monitoring the fetal behavior does not only have implications for acute care but also for identifying developmental disturbances that burden the entire later life. The concept, of 'fetal programming', also known as 'developmental origins of adult disease hypothesis', e.g. applies for cardiovascular, metabolic, hyperkinetic, cognitive disorders. Since the autonomic nervous system is involved in all of those systems, cardiac autonomic control may provide relevant functional diagnostic and prognostic information. The fetal heart rate patterns (HRP) are one of the few functional signals in the prenatal period that relate to autonomic control and, therefore, is predestinated for its evaluation. The development of sensitive markers of fetal maturation and its disturbances requires the consideration of physiological fundamentals, recording technology and HRP parameters of autonomic control. Based on the ESGCO2016 special session on monitoring the fetal maturation we herein report the most recent results on: (i) functional fetal autonomic brain age score (fABAS), Recurrence Quantitative Analysis and Binary Symbolic Dynamics of complex HRP resolve specific maturation periods, (ii) magnetocardiography (MCG) based fABAS was validated for cardiotocography (CTG), (iii) 30 min recordings are sufficient for obtaining episodes of high variability, important for intrauterine growth restriction (IUGR) detection in handheld Doppler, (iv) novel parameters from PRSA to identify Intra IUGR fetuses, (v) evaluation of fetal electrocardiographic (ECG) recordings, (vi) correlation between maternal and fetal HRV is disturbed in pre-eclampsia. The reported novel developments significantly extend the possibilities for the established CTG methodology. Novel HRP indices improve the accuracy of assessment due to their more appropriate consideration of complex autonomic processes across the recording technologies (CTG, handheld Doppler, MCG, ECG). The ultimate objective is their dissemination into routine practice and studies of fetal developmental disturbances with implications for programming of adult diseases.
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Affiliation(s)
- Dirk Hoyer
- Hans Berger Department of Neurology, Biomagnetic Center, Jena University Hospital, Jena 07747, Germany
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20
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Schnettler WT, Goldberger AL, Ralston SJ, Costa M. Complexity analysis of fetal heart rate preceding intrauterine demise. Eur J Obstet Gynecol Reprod Biol 2016; 203:286-90. [PMID: 27400426 DOI: 10.1016/j.ejogrb.2016.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/24/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Visual non-stress test interpretation lacks the optimal specificity and observer-agreement of an ideal screening tool for intrauterine fetal demise (IUFD) syndrome prevention. Computational methods based on traditional heart rate variability have also been of limited value. Complexity analysis probes properties of the dynamics of physiologic signals that are otherwise not accessible and, therefore, might be useful in this context. OBJECTIVE To explore the association between fetal heart rate (FHR) complexity analysis and subsequent IUFD. Our specific hypothesis is that the complexity of the fetal heart rate dynamics is lower in the IUFD group compared with controls. STUDY DESIGN This case-control study utilized cases of IUFD at a single tertiary-care center among singleton pregnancies with at least 10min of continuous electronic FHR monitoring on at least 2 weekly occasions in the 3 weeks immediately prior to fetal demise. Controls delivered a live singleton beyond 35 weeks' gestation and were matched to cases by gestational age, testing indication, and maternal age in a 3:1 ratio. FHR data was analyzed using the multiscale entropy (MSE) method to derive their complexity index. In addition, pNNx, a measure of short-term heart rate variability, which in adults is ascribable primarily to cardiac vagal tone modulation, was also computed. RESULTS 211 IUFDs occurred during the 9-year period of review, but only 6 met inclusion criteria. The median gestational age at the time of IUFD was 35.5 weeks. Three controls were matched to each case for a total of 24 subjects, and 87 FHR tracings were included for analysis. The median gestational age at the first fetal heart rate tracing was similar between groups (median [1st-3rd quartiles] weeks: IUFD cases: 34.7 (34.4-36.2); controls: 35.3 (34.4-36.1); p=.94). The median complexity of the cases' tracings was significantly less than the controls' (12.44 [8.9-16.77] vs. 17.82 [15.21-22.17]; p<.0001). Furthermore, the cases' median complexity decreased as gestation advanced whereas the controls' median complexity increased over time. However, this difference was not statistically significant [-0.83 (-2.03 to 0.47) vs. 0.14 (-1.25 to 0.94); p=.62]. The degree of short-term variability of FHR tracings, as measured by the pNN metric, was significantly lower (p<.005) for the controls (1.1 [0.8-1.3]) than the IUFD cases (1.3 [1.1-1.6]). CONCLUSIONS FHR complexity analysis using multiscale entropy analysis may add value to other measures in detecting and monitoring pregnancies at the highest risk for IUFD. The decrease in complexity and short-term variability seen in the IUFD cases may reflect perturbations in neuroautonomic control due to multiple maternal-fetal factors.
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Affiliation(s)
- William T Schnettler
- The Division Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Ary L Goldberger
- Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Steven J Ralston
- The Division Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Madalena Costa
- Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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21
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Silva LEV, Lataro RM, Castania JA, da Silva CAA, Valencia JF, Murta LO, Salgado HC, Fazan R, Porta A. Multiscale entropy analysis of heart rate variability in heart failure, hypertensive, and sinoaortic-denervated rats: classical and refined approaches. Am J Physiol Regul Integr Comp Physiol 2016; 311:R150-6. [PMID: 27225948 DOI: 10.1152/ajpregu.00076.2016] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/04/2016] [Indexed: 11/22/2022]
Abstract
The analysis of heart rate variability (HRV) by nonlinear methods has been gaining increasing interest due to their ability to quantify the complexity of cardiovascular regulation. In this study, multiscale entropy (MSE) and refined MSE (RMSE) were applied to track the complexity of HRV as a function of time scale in three pathological conscious animal models: rats with heart failure (HF), spontaneously hypertensive rats (SHR), and rats with sinoaortic denervation (SAD). Results showed that HF did not change HRV complexity, although there was a tendency to decrease the entropy in HF animals. On the other hand, SHR group was characterized by reduced complexity at long time scales, whereas SAD animals exhibited a smaller short- and long-term irregularity. We propose that short time scales (1 to 4), accounting for fast oscillations, are more related to vagal and respiratory control, whereas long time scales (5 to 20), accounting for slow oscillations, are more related to sympathetic control. The increased sympathetic modulation is probably the main reason for the lower entropy observed at high scales for both SHR and SAD groups, acting as a negative factor for the cardiovascular complexity. This study highlights the contribution of the multiscale complexity analysis of HRV for understanding the physiological mechanisms involved in cardiovascular regulation.
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Affiliation(s)
- Luiz Eduardo Virgilio Silva
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Renata Maria Lataro
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Jaci Airton Castania
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Carlos Alberto Aguiar da Silva
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Luiz Otavio Murta
- Department of Computing and Mathematics, School of Philosophy, Sciences and Letters, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Helio Cesar Salgado
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rubens Fazan
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil;
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; and Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
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22
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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.
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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
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Adaptive responses of cardiac function to fetal postural change as gestational age increases. Obstet Gynecol Sci 2016; 59:427-433. [PMID: 27896244 PMCID: PMC5120061 DOI: 10.5468/ogs.2016.59.6.427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/20/2016] [Accepted: 06/19/2016] [Indexed: 11/08/2022] Open
Abstract
Objective Methods Results Conclusion
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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.
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Affiliation(s)
- Dirk Hoyer
- Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, 07743, Germany
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Mathewson KJ, Van Lieshout RJ, Saigal S, Morrison KM, Boyle MH, Schmidt LA. Autonomic Functioning in Young Adults Born at Extremely Low Birth Weight. Glob Pediatr Health 2015; 2:2333794X15589560. [PMID: 27335960 PMCID: PMC4784639 DOI: 10.1177/2333794x15589560] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Autonomic functioning is altered in infants born at extremely low birth weight (ELBW; <1000 g), but we know little about how such alterations manifest in adulthood. We examined associations between birth weight and resting heart rate (R-R interval), high-frequency (HF) and low-frequency (LF) heart rate variability, and systolic (SBP) and diastolic (DBP) blood pressure, in 60 participants (ages 22-26) born at ELBW and free of major neurosensory impairment, and 79 controls born at normal birth weight (NBW; >2500 g). HF in the smallest-born ELBW participants was significantly lower than in NBW controls. In both groups, greater birth weight was associated with higher HF. Among ELBW survivors, lower birth weight predicted faster heart rate and higher DBP, but neither heart rate nor DBP appeared to be well-coordinated with baroreflex activity (LF), the principal mechanism for short-term blood pressure regulation. Adult autonomic regulation may be significantly altered in those born extremely preterm.
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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.
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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
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27
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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.
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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
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Hoyer D, Tetschke F, Jaekel S, Nowack S, Witte OW, Schleußner E, Schneider U. Fetal functional brain age assessed from universal developmental indices obtained from neuro-vegetative activity patterns. PLoS One 2013; 8:e74431. [PMID: 24058564 PMCID: PMC3776847 DOI: 10.1371/journal.pone.0074431] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 08/01/2013] [Indexed: 11/18/2022] Open
Abstract
Fetal brain development involves the development of the neuro-vegetative (autonomic) control that is mediated by the autonomic nervous system (ANS). Disturbances of the fetal brain development have implications for diseases in later postnatal life. In that context, the fetal functional brain age can be altered. Universal principles of developmental biology applied to patterns of autonomic control may allow a functional age assessment. The work aims at the development of a fetal autonomic brain age score (fABAS) based on heart rate patterns. We analysed n = 113 recordings in quiet sleep, n = 286 in active sleep, and n = 29 in active awakeness from normals. We estimated fABAS from magnetocardiographic recordings (21.4–40.3 weeks of gestation) preclassified in quiet sleep (n = 113, 63 females) and active sleep (n = 286, 145 females) state by cross-validated multivariate linear regression models in a cross-sectional study. According to universal system developmental principles, we included indices that address increasing fluctuation range, increasing complexity, and pattern formation (skewness, power spectral ratio VLF/LF, pNN5). The resulting models constituted fABAS. fABAS explained 66/63% (coefficient of determination R2 of training and validation set) of the variance by age in quiet, while 51/50% in active sleep. By means of a logistic regression model using fluctuation range and fetal age, quiet and active sleep were automatically reclassified (94.3/93.1% correct classifications). We did not find relevant gender differences. We conclude that functional brain age can be assessed based on universal developmental indices obtained from autonomic control patterns. fABAS reflect normal complex functional brain maturation. The presented normative data are supplemented by an explorative study of 19 fetuses compromised by intrauterine growth restriction. We observed a shift in the state distribution towards active awakeness. The lower WGA dependent fABAS values found in active sleep may reflect alterations in the universal developmental indices, namely fluctuation amplitude, complexity, and pattern formation that constitute fABAS.
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Affiliation(s)
- Dirk Hoyer
- Jena University Hospital, Biomagnetic Center, Hans Berger Department of Neurology, Jena, Germany
- * E-mail:
| | - Florian Tetschke
- Jena University Hospital, Biomagnetic Center, Hans Berger Department of Neurology, Jena, Germany
| | - Susan Jaekel
- Jena University Hospital, Department of Obstetrics, Jena, Germany
| | - Samuel Nowack
- Jena University Hospital, Biomagnetic Center, Hans Berger Department of Neurology, Jena, Germany
- Jena University Hospital, Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena, Germany
| | - Otto W. Witte
- Jena University Hospital, Biomagnetic Center, Hans Berger Department of Neurology, Jena, Germany
| | | | - Uwe Schneider
- Jena University Hospital, Department of Obstetrics, Jena, Germany
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Garzoni L, Faure C, Frasch M. Fetal cholinergic anti-inflammatory pathway and necrotizing enterocolitis: the brain-gut connection begins in utero. Front Integr Neurosci 2013; 7:57. [PMID: 23964209 PMCID: PMC3737662 DOI: 10.3389/fnint.2013.00057] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 07/18/2013] [Indexed: 12/25/2022] Open
Abstract
Necrotizing enterocolitis (NEC) is an acute neonatal inflammatory disease that affects the intestine and may result in necrosis, systemic sepsis and multisystem organ failure. NEC affects 5-10% of all infants with birth weight ≤ 1500 g or gestational age less than 30 weeks. Chorioamnionitis (CA) is the main manifestation of pathological inflammation in the fetus and is strong associated with NEC. CA affects 20% of full-term pregnancies and upto 60% of preterm pregnancies and, notably, is often an occult finding. Intrauterine exposure to inflammatory stimuli may switch innate immunity cells such as macrophages to a reactive phenotype ("priming"). Confronted with renewed inflammatory stimuli during labour or postnatally, such sensitized cells can sustain a chronic or exaggerated production of proinflammatory cytokines associated with NEC (two-hit hypothesis). Via the cholinergic anti-inflammatory pathway, a neurally mediated innate anti-inflammatory mechanism, higher levels of vagal activity are associated with lower systemic levels of proinflammatory cytokines. This effect is mediated by the α7 subunit nicotinic acetylcholine receptor (α7nAChR) on macrophages. The gut is the most extensive organ innervated by the vagus nerve; it is also the primary site of innate immunity in the newborn. Here we review the mechanisms of possible neuroimmunological brain-gut interactions involved in the induction and control of antenatal intestinal inflammatory response and priming. We propose a neuroimmunological framework to (1) study the long-term effects of perinatal intestinal response to infection and (2) to uncover new targets for preventive and therapeutic intervention.
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Affiliation(s)
- L. Garzoni
- CHU Sainte Justine Research Center, MontrealQC, Canada
- Division of Gastroenterology, Hepatology and Nutrition, CHU Sainte-Justine, MontrealQC, Canada
| | - C. Faure
- CHU Sainte Justine Research Center, MontrealQC, Canada
- Division of Gastroenterology, Hepatology and Nutrition, CHU Sainte-Justine, MontrealQC, Canada
| | - M.G. Frasch
- CHU Sainte Justine Research Center, MontrealQC, Canada
- Department of Obstetrics and Gynaecology, University of MontrealMontreal, QC, Canada
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