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Porta-García MÁ, Quiroz-Salazar A, Abarca-Castro EA, Reyes-Lagos JJ. Bradycardia May Decrease Cardiorespiratory Coupling in Preterm Infants. ENTROPY (BASEL, SWITZERLAND) 2023; 25:1616. [PMID: 38136496 PMCID: PMC10743269 DOI: 10.3390/e25121616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023]
Abstract
Bradycardia, frequently observed in preterm infants, presents significant risks due to the immaturity of their autonomic nervous system (ANS) and respiratory systems. These infants may face cardiorespiratory events, leading to severe complications like hypoxemia and neurodevelopmental disorders. Although neonatal care has advanced, the influence of bradycardia on cardiorespiratory coupling (CRC) remains elusive. This exploratory study delves into CRC in preterm infants, emphasizing disparities between events with and without bradycardia. Using the Preterm Infant Cardio-Respiratory Signals (PICS) database, we analyzed interbeat (R-R) and inter-breath intervals (IBI) from 10 preterm infants. The time series were segmented into bradycardic (B) and non-bradycardic (NB) segments. Employing information theory measures, we quantified the irregularity of cardiac and respiratory time series. Notably, B segments had significantly lower entropy values for R-R and IBI than NB segments, while mutual information was higher in NB segments. This could imply a reduction in the complexity of respiratory and cardiac dynamics during bradycardic events, potentially indicating weaker CRC. Building on these insights, this research highlights the distinctive physiological characteristics of preterm infants and underscores the potential of emerging non-invasive diagnostic tools.
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Affiliation(s)
- Miguel Ángel Porta-García
- Center of Research and Innovation in Information Technology and Communication—INFOTEC, Mexico City 14050, Mexico;
- School of Medicine, Autonomous University of the State of Mexico (UAEMéx), Toluca de Lerdo 50180, Mexico;
| | - Alberto Quiroz-Salazar
- School of Medicine, Autonomous University of the State of Mexico (UAEMéx), Toluca de Lerdo 50180, Mexico;
| | - Eric Alonso Abarca-Castro
- Department of Health Sciences, Metropolitan Autonomous University-Lerma (UAM-L), Lerma de Villada 52005, Mexico;
| | - José Javier Reyes-Lagos
- School of Medicine, Autonomous University of the State of Mexico (UAEMéx), Toluca de Lerdo 50180, Mexico;
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Latremouille S, Lam J, Shalish W, Sant'Anna G. Neonatal heart rate variability: a contemporary scoping review of analysis methods and clinical applications. BMJ Open 2021; 11:e055209. [PMID: 34933863 PMCID: PMC8710426 DOI: 10.1136/bmjopen-2021-055209] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Neonatal heart rate variability (HRV) is widely used as a research tool. However, HRV calculation methods are highly variable making it difficult for comparisons between studies. OBJECTIVES To describe the different types of investigations where neonatal HRV was used, study characteristics, and types of analyses performed. ELIGIBILITY CRITERIA Human neonates ≤1 month of corrected age. SOURCES OF EVIDENCE A protocol and search strategy of the literature was developed in collaboration with the McGill University Health Center's librarians and articles were obtained from searches in the Biosis, Cochrane, Embase, Medline and Web of Science databases published between 1 January 2000 and 1 July 2020. CHARTING METHODS A single reviewer screened for eligibility and data were extracted from the included articles. Information collected included the study characteristics and population, type of HRV analysis used (time domain, frequency domain, non-linear, heart rate characteristics (HRC) parameters) and clinical applications (physiological and pathological conditions, responses to various stimuli and outcome prediction). RESULTS Of the 286 articles included, 171 (60%) were small single centre studies (sample size <50) performed on term infants (n=136). There were 138 different types of investigations reported: physiological investigations (n=162), responses to various stimuli (n=136), pathological conditions (n=109) and outcome predictor (n=30). Frequency domain analyses were used in 210 articles (73%), followed by time domain (n=139), non-linear methods (n=74) or HRC analyses (n=25). Additionally, over 60 different measures of HRV were reported; in the frequency domain analyses alone there were 29 different ranges used for the low frequency band and 46 for the high frequency band. CONCLUSIONS Neonatal HRV has been used in diverse types of investigations with significant lack of consistency in analysis methods applied. Specific guidelines for HRV analyses in neonates are needed to allow for comparisons between studies.
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Affiliation(s)
- Samantha Latremouille
- Division of Experimental Medicine, McGill University Health Centre, Montreal, Québec, Canada
| | - Justin Lam
- Medicine, Griffith University, Nathan, Queensland, Australia
| | - Wissam Shalish
- Division of Neonatology, McGill University Health Center, Montreal, Québec, Canada
| | - Guilherme Sant'Anna
- Division of Neonatology, McGill University Health Center, Montreal, Québec, Canada
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Bohnhorst B, Weidlich C, Peter C, Böhne C, Kattner E, Pirr S. Cardiorespiratory Events Following the Second Routine Immunization in Preterm Infants: Risk Assessment and Monitoring Recommendations. Vaccines (Basel) 2021; 9:vaccines9080909. [PMID: 34452034 PMCID: PMC8402520 DOI: 10.3390/vaccines9080909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 11/16/2022] Open
Abstract
Due to frequent cardiorespiratory events (CREs) in response to the first routine immunization (rIM), current guidelines recommend readmitting and monitoring extremely preterm infants after the second rIM, though evidence on CREs in response to the second rIM is weak. In a prospective observational study, preterm infants with an increase in CREs after the first rIM were monitored for CREs before and after the second rIM. Seventy-one infants with a median gestational age of 26.4 weeks and a median weight of 820 g at birth were investigated at a median postnatal age of 94 days. All but seven infants showed an increase in CREs after the second rIM. The frequency of hypoxemias (p < 0.0001), apneas (p = 0.0003) and cardiorespiratory events requiring tactile stimulation (CRE-ts) (p = 0.0034) increased significantly. The 25 infants (35%) presenting with CRE-ts were significantly more likely to have been continuously hospitalized since birth (p = 0.001) and to receive analeptic therapy at the first rIM (p = 0.002) or some kind of respiratory support at the first (p = 0.005) and second rIM (p < 0.0001). At a postmenstruational age of 43.5 weeks, CRE-ts ceased. Our data support the recommendation to monitor infants who fulfil the above-mentioned criteria during the second rIM up to a postmenstruational age of 44 weeks.
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Affiliation(s)
- Bettina Bohnhorst
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, 30625 Hannover, Lower Saxony, Germany; (B.B.); (C.W.); (C.P.); (C.B.)
| | - Cornelia Weidlich
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, 30625 Hannover, Lower Saxony, Germany; (B.B.); (C.W.); (C.P.); (C.B.)
| | - Corinna Peter
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, 30625 Hannover, Lower Saxony, Germany; (B.B.); (C.W.); (C.P.); (C.B.)
| | - Carolin Böhne
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, 30625 Hannover, Lower Saxony, Germany; (B.B.); (C.W.); (C.P.); (C.B.)
| | - Evelyn Kattner
- Department of Neonatology, Children’s Hospital “Auf der Bult”, 30173 Hannover, Lower Saxony, Germany;
| | - Sabine Pirr
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, 30625 Hannover, Lower Saxony, Germany; (B.B.); (C.W.); (C.P.); (C.B.)
- Correspondence:
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Pladys P, Zaoui C, Girard L, Mons F, Reynaud A, Casper C, Kuhn P, Souet G, Fichtner C, Laprugne‐garcia E, Legouais S, Zores C, Thiriez G, Duboz MA, Knezovic‐Daniel N, Renesme L, Brandicourt A, Gonnaud F, Picaud JC, Julie‐Fische C, Tourneux P, Truffert P, Berne Audeoud F, Pierrat V, Caeymaex L, Granier M, Bouvard C, Evrard A, Saliba E, Allen A, Sizun J, Zana‐Taieb E, Huppi P. French neonatal society position paper stresses the importance of an early family-centred approach to discharging preterm infants from hospital. Acta Paediatr 2020; 109:1302-1309. [PMID: 31774567 DOI: 10.1111/apa.15110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 11/23/2019] [Accepted: 11/25/2019] [Indexed: 12/01/2022]
Abstract
AIM The families of hospitalised preterm infants risk depression and post-traumatic stress and the preterm infants risk re-hospitalisation. The French neonatal society's aim was to review the literature on how the transition from hospital to home could limit these risks and to produce a position paper. METHODS A systematic literature review was performed covering 1 January 2000 to 1 January 2018, and multidisciplinary experts examined the scientific evidence. RESULTS We identified 939 English and French papers and 169 are quoted in the position paper. Most studies stressed the importance of early, personalised and progressive involvement of the family. Healthcare staff and families should assess discharge preparations jointly. This evaluation should assess the capacities of the newborn infant, with regard to its physiological maturity. It should also assess the family's ability to supply the medical, psychological and social assistance required before and after discharge. There should be a structured follow-up process that includes effective communication, various tools, interventions, networks, health and social professionals. CONCLUSION Discharge preparations may improve the transition from hospital to home and the outcomes for the parents and newborn preterm infant. This early family-centred approach should be structured, coordinated and based on individual needs and circumstances.
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Affiliation(s)
- Patrick Pladys
- CHU Rennes Inserm LTSI ‐ UMR 1099 Univ Rennes Rennes France
| | | | | | | | - Audrey Reynaud
- SOS‐Prema family association Boulogne‐Billancourt France
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Nguyen Phuc Thu T, Hernández AI, Costet N, Patural H, Pichot V, Carrault G, Beuchée A. Improving methodology in heart rate variability analysis for the premature infants: Impact of the time length. PLoS One 2019; 14:e0220692. [PMID: 31398196 PMCID: PMC6688831 DOI: 10.1371/journal.pone.0220692] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/22/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Heart rate variability (HRV) has been emerging in neonatal medicine. It may help for the early diagnosis of pathology and estimation of autonomous maturation. There is a lack of standardization and automation in the selection of the sequences to analyze and some features have not been explored in this specific population. The main objective of this study was to analyze the impact of the time length of the sequences on the estimation of linear and non-linear HRV features, including horizontal visibility graphs (HVG). METHODS HRV features were repeatedly measured with linear and non-linear methods on 2-, 5-, 10-minute sequences selected from the longest 15-min sequence and recorded on a weekly basis in 39 infants less than 31 weeks at birth. The associations between HRV measurements were analyzed through principal component analysis and k-means clustering. The effects of the time lengths on HRV measurements and post-menstrual age (PMA) were analyzed by linear mixed effect model for repeated measures. RESULTS The domains of analysis were concordant for their descriptive parameters of short (rMSSD, SD1 and HF) and long-term (SD, SD2 and LF) variability. α1 was correlated with the LF/HF and SD2/SD1. DC and AC were correlated with short-term variability estimates and significantly increased with GA and PMA. Shortening the windows of analysis increased the random measurement error for all the features and increased the bias for all but short term features and HVGs. CONCLUSION The linear and non-linear measurements of HRV are correlated each other. Shortening the windows of analysis increased the random error for all the features and increased the bias for all but short term features and HVGs. Short-term HRV can be an index for evaluating the maturation in whatever sequence length.
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Affiliation(s)
- Trang Nguyen Phuc Thu
- Laboratoire Traitement du Signal et de l’Image (LTSI – UMR 1099), Université de Rennes 1, Centre Hospitalier Universitaire de Rennes, Inserm, Rennes, France
- * E-mail:
| | - Alfredo I. Hernández
- Laboratoire Traitement du Signal et de l’Image (LTSI – UMR 1099), Université de Rennes 1, Centre Hospitalier Universitaire de Rennes, Inserm, Rennes, France
| | - Nathalie Costet
- Laboratoire Traitement du Signal et de l’Image (LTSI – UMR 1099), Université de Rennes 1, Centre Hospitalier Universitaire de Rennes, Inserm, Rennes, France
| | - Hugues Patural
- Pôle Mère-Enfants, Réanimation Néonatale – Hôpital Nord, Centre Hospitalier Universitaire Saint-Etienne, Saint-Etienne, France
- Système nerveux autonome - Epidémiologie Physiologie Ingénierie Santé (SNA-EPIS 4607), Université Jean Monnet, Saint-Etienne, France
| | - Vincent Pichot
- Système nerveux autonome - Epidémiologie Physiologie Ingénierie Santé (SNA-EPIS 4607), Université Jean Monnet, Saint-Etienne, France
| | - Guy Carrault
- Laboratoire Traitement du Signal et de l’Image (LTSI – UMR 1099), Université de Rennes 1, Centre Hospitalier Universitaire de Rennes, Inserm, Rennes, France
| | - Alain Beuchée
- Laboratoire Traitement du Signal et de l’Image (LTSI – UMR 1099), Université de Rennes 1, Centre Hospitalier Universitaire de Rennes, Inserm, Rennes, France
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Cardio-respiratory Events and Inflammatory Response After Primary Immunization in Preterm Infants < 32 Weeks Gestational Age: A Randomized Controlled Study. Pediatr Infect Dis J 2017; 36:988-994. [PMID: 28654562 DOI: 10.1097/inf.0000000000001647] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Inflammation may depress respiration in neonates. This study aimed to establish a link between postimmunization inflammation and cardio-respiratory events (CREs). METHODS Randomized double-blind controlled study of infants born < 32 weeks gestation receiving the 2 months vaccine, which comprised diphtheria and tetanus toxoids and acellular pertussis adsorbed combined with inactivated poliomyelitis vaccines and Haemophilus b conjugate and the pneumococcal conjugate 10-valent vaccines. Infants were randomized to ibuprofen treatment or a placebo group (n = 28/group). C-reactive protein (CRP) and prostaglandins E2 (PgE2) levels were assessed before and after immunization. CREs were recorded for 72 hours. Heart rate variability was assessed by polysomnography. RESULTS In the placebo group, immunization was associated with significantly increased CRP levels and an increase in CRE (8.6 ± 11.1 before versus 14.0 ± 12.8 after), which did not reach statistical significance (P = 0.08), and no change in PgE2. The increase in CRP was correlated with changes in CRE (r = 0.4: P < 0.05). In the ibuprofen group, immunization significantly increased CRP levels but was not associated with change in CRE (6.7 ± 7.7 before versus 6.8 ± 9.7 after) and PgE2 levels. Comparing the groups, variation in CRE (ΔCRE before versus after immunization) was significantly lower in the ibuprofen group (0.1 ± 7.9 versus 5.4 ± 10.0 ΔCRE; P < 0.05). CONCLUSION The first immunization of infants born < 32 weeks was associated with an increase in CRP. Ibuprofen treatment significantly attenuated the variation (Δ) in CRE following first immunization in these infants but the current study could not demonstrate an impact on CRP and PgE2 levels. The impact of anti-inflammatory treatment on antigenicity must be evaluated before their clinical use aiming at reducing CRE after immunization in preterm infants.
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Navarro X, Porée F, Kuchenbuch M, Chavez M, Beuchée A, Carrault G. Multi-feature classifiers for burst detection in single EEG channels from preterm infants. J Neural Eng 2017; 14:046015. [DOI: 10.1088/1741-2552/aa714a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Nguyen N, Vandenbroucke L, Hernández A, Pham T, Beuchée A, Pladys P. Early-onset neonatal sepsis is associated with a high heart rate during automatically selected stationary periods. Acta Paediatr 2017; 106:749-754. [PMID: 28196284 DOI: 10.1111/apa.13782] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/27/2016] [Accepted: 02/09/2017] [Indexed: 12/27/2022]
Abstract
AIM This study examined the heart rate variability characteristics associated with early-onset neonatal sepsis in a prospective, observational controlled study. METHODS Eligible patients were full-term neonates hospitalised with clinical signs that suggested early-onset sepsis and a C-reactive protein of >10 mg/L. Sepsis was considered proven in cases of symptomatic septicaemia, meningitis, pneumonia or enterocolitis. Heart rate variability parameters (n = 16) were assessed from five-, 15- and 30-minute stationary sequences automatically selected from electrocardiographic recordings performed at admission and compared with a control group using the U-test with post hoc Benjamini-Yekutieli correction. Stationary sequences corresponded to the periods with the lowest changes of heart rate variability over time. RESULTS A total of 40 full-term infants were enrolled, including 14 with proven sepsis. The mean duration of the cardiac cycle length was lower in the proven sepsis group than in the control group (n = 11), without other significant changes in heart rate variability parameters. These durations, measured in five-minute stationary periods, were 406 (367-433) ms in proven sepsis group versus 507 (463-522) ms in the control group (p < 0.05). CONCLUSION Early-onset neonatal sepsis was associated with a high mean heart rate measured during automatically selected stationary periods.
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Affiliation(s)
- Nga Nguyen
- Inserm, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
- Department of Pediatrics; Hanoi Medical University; Hanoi Vietnam
- Neonatal Department; National Hospital of Pediatrics; Hanoi Vietnam
| | - Laurent Vandenbroucke
- Inserm, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
- Obstetrics Department; CHU Rennes; Rennes France
| | - Alfredo Hernández
- Inserm, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
| | - Tu Pham
- Hanoi French Hospital; Hanoi Vietnam
| | - Alain Beuchée
- Inserm, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
- Division of Neonatology and CIC-1414; Department of Pediatrics; CHU Rennes; Rennes France
| | - Patrick Pladys
- Inserm, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
- Division of Neonatology and CIC-1414; Department of Pediatrics; CHU Rennes; Rennes France
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Montague EC, Hilinski JA, Williams HO, McCracken CE, Giannopoulos HT, Piazza AJ. Respiratory Decompensation and Immunization of Preterm Infants. Pediatrics 2016; 137:peds.2015-4225. [PMID: 27244819 DOI: 10.1542/peds.2015-4225] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Concern for respiratory decompensation after immunization in premature infants, particularly those with bronchopulmonary dysplasia (BPD), may lead to delayed and altered immunization schedules. METHODS A retrospective cohort of premature infants at <32 weeks' gestational age cared for in a tertiary level 4 NICU and immunized during their hospital stay were evaluated for respiratory decompensation within 72 hours of immunization. Respiratory measurements including change in respiratory support, mean fraction of inspired oxygen, and apnea, bradycardia, and desaturation events were compared between those infants with BPD and those without. The primary outcome was the difference in respiratory decompensation defined as a composite of increased respiratory support or increased fraction of inspired oxygen ≥10% within 72 hours of immunization. RESULTS Of 403 infants admitted to the NICU and immunized, 240 met the study criteria. Of those infants, 172 had a diagnosis of BPD. There was no difference in the primary outcome of respiratory decompensation after immunization between groups (P = .65). There was also no significant difference in apnea, bradycardia, and desaturation events between groups (P = .51). CONCLUSIONS In this cohort, respiratory decompensation requiring clinical intervention after immunization of preterm infants both with and without BPD was uncommon and not significantly different between groups. Consideration for immunization of this vulnerable population should not be delayed out of concern for clinical deterioration.
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Affiliation(s)
- Edwin Clark Montague
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia; and
| | - Joseph A Hilinski
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia; and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Helen O Williams
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia; and Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | | | - Anthony J Piazza
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia; and Children's Healthcare of Atlanta, Atlanta, Georgia
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McArdle AJ, Mugisha G, Birahinduka D. QUESTION 2: Vaccinating preterm infants in resource-poor settings: what is the incidence of apnoea, bradycardia and need for respiratory support? Arch Dis Child 2016; 101:290-3. [PMID: 26893515 DOI: 10.1136/archdischild-2015-310273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Guy Mugisha
- Hôpital Militaire de Kamenge, Bujumbura, Burundi
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Pladys P, Vandenbroucke L, Hernandez A, Beuchée A. Intérêt des mesures de variabilité du rythme cardiaque dans le sepsis. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-014-1013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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