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Hussain NM, Amin B, McDermott BJ, Dunne E, O’Halloran M, Elahi A. Feasibility Analysis of ECG-Based pH Estimation for Asphyxia Detection in Neonates. SENSORS (BASEL, SWITZERLAND) 2024; 24:3357. [PMID: 38894148 PMCID: PMC11174966 DOI: 10.3390/s24113357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024]
Abstract
Birth asphyxia is a potential cause of death that is also associated with acute and chronic morbidities. The traditional and immediate approach for monitoring birth asphyxia (i.e., arterial blood gas analysis) is highly invasive and intermittent. Additionally, alternative noninvasive approaches such as pulse oximeters can be problematic, due to the possibility of false and erroneous measurements. Therefore, further research is needed to explore alternative noninvasive and accurate monitoring methods for asphyxiated neonates. This study aims to investigate the prominent ECG features based on pH estimation that could potentially be used to explore the noninvasive, accurate, and continuous monitoring of asphyxiated neonates. The dataset used contained 274 segments of ECG and pH values recorded simultaneously. After preprocessing the data, principal component analysis and the Pan-Tompkins algorithm were used for each segment to determine the most significant ECG cycle and to compute the ECG features. Descriptive statistics were performed to describe the main properties of the processed dataset. A Kruskal-Wallis nonparametric test was then used to analyze differences between the asphyxiated and non-asphyxiated groups. Finally, a Dunn-Šidák post hoc test was used for individual comparison among the mean ranks of all groups. The findings of this study showed that ECG features (T/QRS, T Amplitude, Tslope, Tslope/T, Tslope/|T|, HR, QT, and QTc) based on pH estimation differed significantly (p < 0.05) in asphyxiated neonates. All these key ECG features were also found to be significantly different between the two groups.
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Affiliation(s)
- Nadia Muhammad Hussain
- Electrical and Electronic Engineering, University of Galway, H91 TK33 Galway, Ireland
- Translational Medical Device Lab, University of Galway, H91 TK33 Galway, Ireland
| | - Bilal Amin
- Electrical and Electronic Engineering, University of Galway, H91 TK33 Galway, Ireland
- Translational Medical Device Lab, University of Galway, H91 TK33 Galway, Ireland
- School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Barry James McDermott
- Electrical and Electronic Engineering, University of Galway, H91 TK33 Galway, Ireland
- School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Eoghan Dunne
- Electrical and Electronic Engineering, University of Galway, H91 TK33 Galway, Ireland
- Translational Medical Device Lab, University of Galway, H91 TK33 Galway, Ireland
- School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Martin O’Halloran
- Electrical and Electronic Engineering, University of Galway, H91 TK33 Galway, Ireland
- Translational Medical Device Lab, University of Galway, H91 TK33 Galway, Ireland
- School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Adnan Elahi
- Electrical and Electronic Engineering, University of Galway, H91 TK33 Galway, Ireland
- Translational Medical Device Lab, University of Galway, H91 TK33 Galway, Ireland
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Kiselev AR, Mureeva EN, Skazkina VV, Panina OS, Karavaev AS, Chernenkov YV. Full-Term and Preterm Newborns Differ More Significantly in Photoplethysmographic Waveform Variability than Heart Rate Variability. Life (Basel) 2024; 14:675. [PMID: 38929659 PMCID: PMC11204696 DOI: 10.3390/life14060675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Features of cardiovascular autonomic regulation in infants are poorly studied compared with adults. However, the clinical significance of autonomic dysfunction in infants is very high. The goal of our research was to study the temporal and frequency-dependent features, as well as low-frequency synchronization in cardiovascular autonomic regulation in full-term vs. preterm newborns, based on the analysis of their heart rate variability (HRV) and photoplethysmographic waveform variability (PPGV). METHODS The study included three groups of newborns: 64 full-term newborns (with a gestational age at birth of 37-40 weeks) with a physiological course of the neonatal adaptation; 23 full-term newborns (with a gestational age at birth of 37-40 weeks) with a pathological course of the neonatal adaptation; and 17 preterm newborns (with a postconceptional age of 34 weeks or more). We conducted spectral analysis of HRV and PPGV, along with an assessment of the synchronization strength between low-frequency oscillations in HRV and in PPGV (synchronization index). We employed several options for the boundaries of the high-frequency (HF) band: 0.15-0.40 Hz, 0.2-2 Hz, 0.15-0.8 Hz, and 0.24-1.04 Hz. RESULTS Preterm newborns had higher heart rate, RMSSD, and PNN50 values relative to both groups of full-term newborns. Values of SDNN index and synchronization index (S index) were similar in all groups of newborns. Differences in frequency domain indices of HRV between groups of newborns depended on the considered options of HF band boundaries. Values of frequency domain indices of PPGV demonstrated similar differences between groups, regardless of the boundaries of considered options of HF bands and the location of PPG signal recording (forehead or leg). An increase in sympathetic influences on peripheral blood flow and a decrease in respiratory influences were observed along the following gradient: healthy full-term newborns → preterm newborns → full-term newborns with pathology. CONCLUSIONS Differences in frequency domain indices of autonomic regulation between the studied groups of newborns depended on the boundaries of the considered options of the HF band. Frequency domain indices of PPGV revealed significantly more pronounced differences between groups of newborns than analogous HRV indicators. An increase in sympathetic influences on peripheral blood flow and a decrease in respiratory influences were observed along the following gradient: healthy full-term newborns → preterm newborns → full-term newborns with pathology.
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Affiliation(s)
- Anton R. Kiselev
- Coordinating Center for Fundamental Research, National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia
| | - Elena N. Mureeva
- Department of Pediatrics and Neonatology, Saratov State Medical University, 410012 Saratov, Russia
| | - Viktoria V. Skazkina
- Department of Dynamic Modeling and Biomedical Engineering, Saratov State University, 410012 Saratov, Russia
| | - Olga S. Panina
- Department of Pediatrics and Neonatology, Saratov State Medical University, 410012 Saratov, Russia
| | - Anatoly S. Karavaev
- Department of Dynamic Modeling and Biomedical Engineering, Saratov State University, 410012 Saratov, Russia
| | - Yuri V. Chernenkov
- Department of Pediatrics and Neonatology, Saratov State Medical University, 410012 Saratov, Russia
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Shiono A, Bonno M, Toyoda H, Ogawa M, Tanaka S, Hirayama M. Autonomic Nervous System in Preterm Very Low Birth Weight Neonates with Intraventricular Hemorrhage. Am J Perinatol 2024; 41:e577-e583. [PMID: 35977712 DOI: 10.1055/a-1926-0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Heart rate variability (HRV) indicates cardiac autonomic nerve activity and is influenced by brain damage during the neonatal period. We aimed to determine whether a correlation exists between the HRV of extremely preterm neonates and neurodevelopmental test scores. STUDY DESIGN Electrocardiogram data of neonates were assessed and HRV patterns in extremely preterm neonates with severe intraventricular hemorrhage (IVH; n = 6) and those with no/mild IVH (n = 28) were compared. We analyzed the relationship between HRV and neurodevelopmental outcomes at 18 months (n = 21) and 3 years (n = 23) in extremely preterm neonates. RESULTS HRV was significantly associated with IVH severity in extremely preterm neonates (p < 0.05). Neonates with severe IVH exhibited increased HR and decreased mean R-to-R interval (NN) compared with neonates with no/mild IVH. HRV parameters significantly decreased in the severe IVH group, but not in the no/mild IVH group, suggesting that both sympathetic and parasympathetic activities decreased in neonates with severe IVH. Additionally, decreased HR and increased NN were significantly related to impaired neurodevelopmental outcomes in the no/mild IVH group at corrected ages of 18 months and 3 years, respectively (all p < 0.05). CONCLUSION HRV was significantly associated with IVH severity and neurodevelopmental outcome in extremely preterm neonates. HRV can distinguish extremely preterm neonates who subsequently had severe IVH from those who had no/low-grade IVH. HRV may identify extremely preterm neonates needing adjuvant neuroprotective interventions. These findings warrant further investigation in a larger population of extremely preterm neonates. KEY POINTS · HRV was associated with IVH severity.. · HRV can predict subsequent severe IVH in extremely preterm neonates.. · HRV are predictive of neurodevelopmental outcomes in extremely premature neonates with low-grade IVH..
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Affiliation(s)
- Ai Shiono
- Department of Neonatology and Pediatrics, National Hospital Organization Mie Chuo Medical Center, Mie, Japan
- Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan
| | - Motoki Bonno
- Department of Neonatology and Pediatrics, National Hospital Organization Mie Chuo Medical Center, Mie, Japan
| | - Hidemi Toyoda
- Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan
| | - Masahiro Ogawa
- Department of Neonatology and Pediatrics, National Hospital Organization Mie Chuo Medical Center, Mie, Japan
| | - Shigeki Tanaka
- Department of Neonatology and Pediatrics, National Hospital Organization Mie Chuo Medical Center, Mie, Japan
| | - Masahiro Hirayama
- Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan
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Uusitalo A, Tikkakoski A, Lehtinen P, Ylänen K, Poutanen T, Korhonen PH. Heart rate in newborns is associated with age, sex and maternal levothyroxine therapy. Acta Paediatr 2024; 113:973-979. [PMID: 38305638 DOI: 10.1111/apa.17140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
AIM To evaluate the definition and causes of neonatal bradycardias. METHODS This retrospective study included 135 term-born newborns referred for 24-hour Holter monitoring due to bradycardia. Bradycardia was defined as either a heart rate below 80 beats per minute (standard definition) or a heart rate below our recently published age-specific reference values for neonatal heart rate. RESULTS The mean (SD) age was 6.1 (1.3) days. With standard definition, 107 newborns (79%) had bradycardia, whereas only 20 (15%) had a minimum heart rate lower than the age-specific reference. Younger newborns had lower heart rates. Each day increased the minimum, mean and maximum heart rate by 1.8 (95% CI: 1.0, 2.6), 4.2 (95% CI: 3.0, 5.3) and 2.1 beats per minute (95% CI: 0.3, 3.8), respectively. Male sex and maternal levothyroxine medication were negatively associated with the mean and maximum heart rate. None of the newborns had a cardiac cause for low heart rate. CONCLUSION Among term newborns with bradycardias, younger age, male sex and maternal levothyroxine medication were associated with a lower heart rate on Holter monitoring. Given the age-related increase in heart rate, the 80 beats per minute limit as a universal threshold for abnormal heart rate in newborns appears inappropriate.
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Affiliation(s)
- Asta Uusitalo
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antti Tikkakoski
- Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, Tampere, Finland
| | - Pieta Lehtinen
- Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, Tampere, Finland
| | - Kaisa Ylänen
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tuija Poutanen
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Päivi H Korhonen
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Beissel A, Denis A, Laborie S, Pillet F, Gauthier-Moulinier H, Hommey S, Tume LN, Butin M, Touzet S. Impact of a nurse education programme on oral feeding in a neonatal unit. Nurs Crit Care 2024; 29:287-295. [PMID: 36054567 DOI: 10.1111/nicc.12840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Premature neonates often experience feeding difficulties during their hospital stay, and evidence-based interventions have been shown to improve feeding outcomes. AIM This study investigated whether an infant-cue based nurse educational feeding bundle accelerates the achievement of independent oral feeding in neonates in a neonatal intensive care unit. STUDY DESIGN A quality improvement study with a pre, during and post intervention test design. All premature neonates admitted to the unit were eligible. The feeding programme included a four-month nurse training module and nurse coaching. RESULTS A hundred and twenty-five nurses or nurse assistants attended the programme and 706 neonates were included. The median time to independent oral feeding (IOF) was 40, 36 and 37 days, respectively, for pre, during and post intervention. The reduction in time to IOF observed during the post-intervention period compared with the baseline period was significant (HR = 1.32, CI 95%: 1.01-1.74). No difference was noted in the length of hospital stay between the three study periods. CONCLUSIONS An infant-cue based nurse educational feeding bundle can promote earlier achievement of IOF in preterm neonates. RELEVANCE TO CLINICAL PRACTICE This quality improvement study demonstrates the impact that a nurse-driven intervention in neonatal care can have on improving practice. Feeding interventions involve the early introduction of oral feeding, non-nutritive sucking (NNS), and oral motor stimulation, and should be individualized for each neonate. These individualized feeding interventions applied by all nurses and assistant nurses, can facilitate the achievement of earlier independent oral feeding in preterm infants and should be included in neonatal critical care nurse education programs.
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Affiliation(s)
- Anne Beissel
- Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Angélique Denis
- Université Lyon I, Villeurbanne, France
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France
- CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Sophie Laborie
- Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Fabienne Pillet
- Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | | | - Sophie Hommey
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Recherche Clinique et Épidémiologique, Lyon, France
| | - Lyvonne N Tume
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
- Paediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool, UK
| | - Marine Butin
- Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- International center for research in infectiology, INSERM U1111, CNRS UMR5308, University of Lyon 1, Lyon, France
| | - Sandrine Touzet
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Recherche Clinique et Épidémiologique, Lyon, France
- Université Lyon 1, Research on Healthcare Performance Lab, Lyon, France
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Mercado L, Escalona-Vargas D, Siegel ER, Preissl H, Bolin EH, Eswaran H. Exploring the Influence of Fetal Sex on Heart Rate Dynamics Using Fetal Magnetocardiographic Recordings. Reprod Sci 2024; 31:823-831. [PMID: 37884730 DOI: 10.1007/s43032-023-01384-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023]
Abstract
Fetal sex has been associated with different development trajectories that cause structural and functional differences between the sexes throughout gestation. Fetal magnetocardiography (fMCG) recordings from 123 participants (64 females and 59 males; one recording/participant) from a database consisting of low-risk pregnant women were analyzed to explore and compare fetal development trajectories of both sexes. The gestational age of the recordings ranged from 28 to 38 weeks. Linear metrics in both the time and frequency domains were applied to study fetal heart rate variability (fHRV) measures that reveal the dynamics of short- and long-term variability. Rates of linear change with GA in these metrics were analyzed using general linear model regressions with assessments for significantly different variances and GA regression slopes between the sexes. The fetal sexes were well balanced for GA and sleep state. None of the fHRV measures analyzed exhibited significant variance heterogeneity between the sexes, and none of them exhibited a significant sex-by-GA interaction. The absence of a statistically significant sex-by-GA interaction on all parameters resulted in none of the regression slope estimates being significantly different between the sexes. With high-precision fMCG recordings, we were able to explore the variation in fHRV parameters as it relates to fetal sex. The fMCG-based fHRV parameters did not show any significant difference in rates of change with gestational age between sexes. This study provides a framework for understanding normal development of the fetal autonomic nervous system, especially in the context of fetal sex.
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Affiliation(s)
- Luis Mercado
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Diana Escalona-Vargas
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, AR, USA
| | - Eric R Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Hubert Preissl
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the Eberhard Karls University of Tübingen, fMEG Center, Tübingen, Germany
| | - Elijah H Bolin
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, AR, USA
| | - Hari Eswaran
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA.
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Filippa M, Nardelli M, Sansavini A, Meloni S, Picciolini O, Lunardi C, Cecchi A, Corvaglia L, Grandjean D, Scilingo EP, Della Casa E, Berardi A, Ferrari F. Maternal singing sustains preterm hospitalized newborns' autonomic nervous system maturation: an RCT. Pediatr Res 2024; 95:1110-1116. [PMID: 38057574 PMCID: PMC10920191 DOI: 10.1038/s41390-023-02932-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Premature birth is known to affect the newborn's autonomic nervous system (ANS) maturation, with potential short and long-term impact on their neurobehavioral development. The purpose of the study was to investigate the effects of maternal directed singing and speaking on the preterm infants' autonomic nervous system (ANS) maturation as measured by the heart rate variability (HRV) parameters. METHODS In this multi-center randomized clinical trial, 30 stable preterm infants (m = 29,6 weeks of gestational age), without any abnormalities were randomized into an intervention (16) or a control group (14). HRV was measured weekly, for a total of 80 recordings during hospitalization, as well as before and after each session of singing or speaking. RESULTS The intervention group showed a significant increase of the percentage value of HRV power in the high frequency range when compared to the control group (p = 0.044). More specifically, the maternal singing significantly increased the high frequency power and decreased the low/high frequency power ratio (p = 0.037). CONCLUSIONS The preterm infant's vagal activity significantly increased in the intervention group, potentially enhancing their ANS maturation. The effect is specifically evidenced in the singing condition. IMPACT Maternal singing affects the autonomic nervous system maturation of preterm hospitalized newborns in the NICU. No previous studies investigated how early vocal parental intervention can affect preterm infants developement, throught their autonomic nervous system maturation. Early Vocal Contact as an early intervention involving parents has a positive impact on preterm infant's development and it can be easily implemented in the care of preterm infants. TRIAL REGISTRATION NCT04759573, retrospectively registered, 17 February 2021.
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Affiliation(s)
- Manuela Filippa
- Division of Development and Growth, Department of Pediatrics, University of Geneva, Geneva, Switzerland.
- Department of Psychology and Educational Sciences, University of Geneva, 24, rue General Dufour, 1211, Geneva, Switzerland.
| | - Mimma Nardelli
- Bioengineering and Robotics Research Centre E. Piaggio and Dipartimento di Ingegneria dell'Informazione, University of Pisa, 56122, Pisa, Italy
| | - Alessandra Sansavini
- Department of Psychology "Renzo Canestrari", University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
| | - Sara Meloni
- Pediatric Physical Medicine & Rehabilitation Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Odoardo Picciolini
- Pediatric Physical Medicine & Rehabilitation Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Clara Lunardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Careggi University Hospital of Florence, Florence, Italy
| | - Alessandra Cecchi
- Division of Neonatology, Careggi University Hospital, University of Florence School of Medicine, Florence, Italy
| | - Luigi Corvaglia
- Neonatal Intensive Care Unit, IRCCS AOU Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Didier Grandjean
- Department of Psychology and Educational Sciences, University of Geneva, 24, rue General Dufour, 1211, Geneva, Switzerland
| | - Enzo Pasquale Scilingo
- Bioengineering and Robotics Research Centre E. Piaggio and Dipartimento di Ingegneria dell'Informazione, University of Pisa, 56122, Pisa, Italy
| | - Elisa Della Casa
- Women's and Children's Health Department, Neonatal Intensive Care Unit, University Hospital of Modena, Modena, Italy
| | - Alberto Berardi
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University Hospital of Modena, Modena, Italy
| | - Fabrizio Ferrari
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University Hospital of Modena, Modena, Italy
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Zanelli SA, Abubakar M, Andris R, Patwardhan K, Fairchild KD, Vesoulis ZA. Early Vital Sign Differences in Very Low Birth Weight Infants with Severe Intraventricular Hemorrhage. Am J Perinatol 2023; 40:1193-1201. [PMID: 34450675 PMCID: PMC9188354 DOI: 10.1055/s-0041-1733955] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Severe intraventricular hemorrhage (sIVH, grades 3 and 4) is a serious complication for very low birth weight (VLBW) infants and is often clinically silent requiring screening cranial ultrasound (cUS) for detection. Abnormal vital sign (VS) patterns might serve as biomarkers to identify risk or occurrence of sIVH. STUDY DESIGN This retrospective study was conducted in VLBW infants admitted to two level-IV neonatal intensive care units (NICUs) between January 2009 and December 2018. Inclusion criteria were: birth weight <1.5 kg and gestational age (GA) <32 weeks, at least 12 hours of systemic oxygen saturation from pulse oximetry (SpO2) data over the first 24 hours and cUS imaging. Infants were categorized as early sIVH (sIVH identified in the first 48 hours), late sIVH (sIVH identified after 48 hours and normal imaging in the first 48 hours), and no IVH. Infants with grades 1 and 2 or unknown timing IVH were excluded. Mean heart rate (HR), SpO2, mean arterial blood pressure (MABP), number of episodes of bradycardia (HR < 100 bpm), and desaturation (SpO2 < 80%) were compared. RESULTS A total of 639 infants (mean: 27 weeks' gestation) were included (567 no IVH, 34 early sIVH, and 37 late sIVH). In the first 48 hours, those with sIVH had significantly higher HR compared with those with no IVH. Infants with sIVH also had lower mean SpO2 and MABP and more desaturations <80%. No significant differences in VS patterns were identified in early versus late sIVH. Logistic regression identified higher HR and greater number of desaturations <80% as independently associated with sIVH. CONCLUSION VLBW infants who develop sIVH demonstrate VS differences with significantly lower SpO2 and higher mean HR over the first 48 hours after birth compared with VLBW infants with no IVH. Abnormalities in early VS patterns may be a useful biomarker for sIVH. Whether VS abnormalities predict or simply reflect sIVH remains to be determined. KEY POINTS · A higher HR in the first 48 hours is seen in infants with severe IVH.. · Infants with sIVH have lower blood pressure in the first 48 hours.. · Infants with sIVH have more oxygen desaturations in the first 48 hours..
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Affiliation(s)
- Santina A. Zanelli
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Maryam Abubakar
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Robert Andris
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Kavita Patwardhan
- Department of Pediatrics, Division of Newborn Medicine, Washington University, St. Louis, Missouri
| | - Karen D. Fairchild
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Zachary A. Vesoulis
- Department of Pediatrics, Division of Newborn Medicine, Washington University, St. Louis, Missouri
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Kuderava Z, Kozar M, Visnovcova Z, Ferencova N, Tonhajzerova I, Prsova L, Zibolen M. Sympathetic nervous system activity and pain-related response indexed by electrodermal activity during the earliest postnatal life in healthy term neonates. Physiol Res 2023; 72:393-401. [PMID: 37449751 PMCID: PMC10668994 DOI: 10.33549/physiolres.935061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/16/2023] [Indexed: 08/26/2023] Open
Abstract
Sympathetic nervous system (SNS) undergoes a prolonged period of fetal and neonatal development and maturation during which is vulnerable to a variety of influences (e.g. painful experiences). Thus, we aimed to evaluate SNS activity at rest and in response to stressful stimulus (pain) within the earliest postnatal life in healthy term neonates using electrodermal activity (EDA) measures. In twenty eutrophic healthy term neonates EDA was recorded within the first two hours after birth (measurement 1 - M1) and 72 h after birth (measurement 2 - M2) at rest and in response to pain (M1 - intramuscular K vitamin administration; M2 - heel stick). Evaluated parameters were skin conductance level (SCL), non-specific skin conductance responses (NS.SCRs), skin SCL 10 s before pain stimulus (SCL_10 before pain), skin conductance response (SCR) peak after pain stimulus, SCL 10 s after pain stimulus (SCL_10 after pain), SCR magnitude, latency, SCR rise/decline time, SCR half recovery time. SCL was significantly decreased at rest during M2 compared to M1 (p=0.010). SCL_10 before pain, SCR peak after pain, and SCL_10 after pain stimulus were significantly decreased in M2 compared to M1 (p=0.014, p=0.020, p=0.011, respectively). SCL was significantly decreased and NS.SCRs were significantly higher in the recovery period after the pain stimulus during M2 compared to M1 (p=0.015, p=0.032, respectively). Our results indicate EDA parameters sensitive to detect sympathetic changes during the earliest postnatal life reflecting its potential in early diagnosis of the autonomic maturation - linked pathological states in neonates.
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Affiliation(s)
- Z Kuderava
- Department of Neonatology, University Hospital in Martin and Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic.
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Lenasi H, Rihar E, Filipič J, Klemenc M, Fister P. The Effect of Caffeine on Heart Rate Variability in Newborns: A Pilot Study. Life (Basel) 2023; 13:1459. [PMID: 37511834 PMCID: PMC10381585 DOI: 10.3390/life13071459] [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: 05/24/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
Neonatal apnoea can be treated with caffeine, which affects the central nervous and cardiovascular systems. Heart rate variability (HRV) reflects the activity of the autonomic nervous system (ANS) and might be used as a measure of ANS maturation in newborns. We aimed to establish the effect of caffeine on HRV in newborns and investigated the potential correlation between HRV and postmenstrual age (PMA). In 25 haemodynamically stable newborns hospitalized due to apnoea and treated with caffeine (2.5 mg/kg), we assessed breathing frequency, arterial oxygen saturation, body temperature, and the heart rate while they were sleeping. We assessed HRV by spectral analysis using fast Fourier transformation. The same protocol was reapplied 100 h after caffeine withdrawal to assess the control parameters. Caffeine increased breathing frequency (p = 0.023) but did not affect any other parameter assessed including HRV. We established a positive correlation between postmenstrual age and HRV during treatment with caffeine as well as after caffeine had been withdrawn (total power: p = 0.044; low-frequency band: p = 0.039). Apparently, the maintenance dose of caffeine is too low to affect the heart rate and HRV. A positive correlation between PMA and HRV might reflect maturation of the ANS, irrespective of caffeine treatment.
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Affiliation(s)
- Helena Lenasi
- Institute of Physiology, Medical Faculty, University of Ljubljana, Zaloška cesta 4, 1000 Ljubljana, Slovenia
| | - Eva Rihar
- Children's Hospital, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
| | - Jerneja Filipič
- Children's Hospital, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
| | - Matjaž Klemenc
- Department of Cardiology, General Hospital Dr. Franc Derganc, Ulica Padlih Borcev 13A, 5290 Šempeter pri Gorici, Slovenia
| | - Petja Fister
- Children's Hospital, Pediatric Intensive Care Unit, University Medical Centre Ljubljana, Bohoričeva ulica 20, 1000 Ljubljana, Slovenia
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Claiborne A, Williams A, Jolly C, Isler C, Newton E, May L, George S. Methods for analyzing infant heart rate variability: A preliminary study. Birth Defects Res 2023; 115:998-1006. [PMID: 37078641 PMCID: PMC11226182 DOI: 10.1002/bdr2.2177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/27/2023] [Accepted: 04/02/2023] [Indexed: 04/21/2023]
Abstract
Heart rate (HR) and heart rate variability (HRV) reflect autonomic development in infants. To better understand the autonomic response in infants, reliable HRV recordings are vital, yet no protocol exists. The purpose of this paper is to present reliability of a common procedure for analysis from two different file types. In the procedure, continuous electrocardiograph recordings of 5-10 min are obtained at rest in infants at 1 month of age by using a Hexoskin Shirt-Junior's (Carre Technologies Inc., Montreal, QC, Canada). Electrocardiograph (ECG; .wav) and R-R interval (RRi; .csv) files are extracted. The RRi of the ECG signal is generated by VivoSense (Great Lakes NeuroTechnologies, Independence, OH). Two MATLAB (The MathWorks, Inc., Natick, MA) scripts converted files for analysis with Kubios HRV Premium (Kubios Oy, Kuopio, Finland). A comparison was made between RRi and ECG files for HR and HRV parameters, and then tested with t tests and correlations via SPSS. There are significant differences in root mean squared successive differences between recording types, with only HR and low-frequency measures significantly correlated together. Recording with Hexoskin and analysis with MATLAB and Kubios enable infant HRV analysis. Differences in outcomes exist between procedures, and standard methodology for infant HR analysis is needed.
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Affiliation(s)
- Alex Claiborne
- Human Performance Laboratory, Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
| | - Alexandra Williams
- Department of Engineering, East Carolina University, Greenville, North Carolina, USA
| | - Colby Jolly
- Human Performance Laboratory, Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
| | - Christy Isler
- Obstetrics and Gynecology, East Carolina University, Greenville, North Carolina, USA
| | - Edward Newton
- Obstetrics and Gynecology, East Carolina University, Greenville, North Carolina, USA
- Faculty of Family Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Linda May
- Human Performance Laboratory, Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
- Obstetrics and Gynecology, East Carolina University, Greenville, North Carolina, USA
| | - Stephanie George
- Department of Engineering, East Carolina University, Greenville, North Carolina, USA
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de Vries LM, Amelynck S, Nyström P, van Esch L, Van Lierde T, Warreyn P, Roeyers H, Noens I, Naulaers G, Boets B, Steyaert J. Investigating the development of the autonomic nervous system in infancy through pupillometry. J Neural Transm (Vienna) 2023; 130:723-734. [PMID: 36906867 PMCID: PMC10008146 DOI: 10.1007/s00702-023-02616-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 02/27/2023] [Indexed: 03/13/2023]
Abstract
We aim to investigate early developmental trajectories of the autonomic nervous system (ANS) as indexed by the pupillary light reflex (PLR) in infants with (i.e. preterm birth, feeding difficulties, or siblings of children with autism spectrum disorder) and without (controls) increased likelihood for atypical ANS development. We used eye-tracking to capture the PLR in 216 infants in a longitudinal follow-up study spanning 5 to 24 months of age, and linear mixed models to investigate effects of age and group on three PLR parameters: baseline pupil diameter, latency to constriction and relative constriction amplitude. An increase with age was found in baseline pupil diameter (F(3,273.21) = 13.15, p < 0.001, [Formula: see text] = 0.13), latency to constriction (F(3,326.41) = 3.84, p = 0.010, [Formula: see text] = 0.03) and relative constriction amplitude(F(3,282.53) = 3.70, p = 0.012, [Formula: see text] = 0.04). Group differences were found for baseline pupil diameter (F(3,235.91) = 9.40, p < 0.001, [Formula: see text] = 0.11), with larger diameter in preterms and siblings than in controls, and for latency to constriction (F(3,237.10) = 3.48, p = 0.017, [Formula: see text] = 0.04), with preterms having a longer latency than controls. The results align with previous evidence, with development over time that could be explained by ANS maturation. To better understand the cause of the group differences, further research in a larger sample is necessary, combining pupillometry with other measures to further validate its value.
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Affiliation(s)
- Lyssa M de Vries
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Herestraat 49 Box 1029, 3000, Louvain, Belgium.
- University Hospital Leuven, Louvain, Belgium.
- Leuven Autism Research (LAuRes), KU Leuven, Louvain, Belgium.
| | - Steffie Amelynck
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Herestraat 49 Box 1029, 3000, Louvain, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Louvain, Belgium
| | - Pär Nyström
- Developmental Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Lotte van Esch
- Leuven Autism Research (LAuRes), KU Leuven, Louvain, Belgium
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Louvain, Belgium
| | - Thijs Van Lierde
- RIDDL Lab, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Petra Warreyn
- RIDDL Lab, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Herbert Roeyers
- RIDDL Lab, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Ilse Noens
- Leuven Autism Research (LAuRes), KU Leuven, Louvain, Belgium
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Louvain, Belgium
| | - Gunnar Naulaers
- University Hospital Leuven, Louvain, Belgium
- Woman and Child, Department of Development and Regeneration, KU Leuven, Louvain, Belgium
| | - Bart Boets
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Herestraat 49 Box 1029, 3000, Louvain, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Louvain, Belgium
| | - Jean Steyaert
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Herestraat 49 Box 1029, 3000, Louvain, Belgium
- University Hospital Leuven, Louvain, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Louvain, Belgium
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Patural H, Pichot V, Roche F, Giraud A. Why, when and how to assess autonomic nervous system maturation in neonatal care units: A practical overview. Neurophysiol Clin 2023; 53:102855. [PMID: 36965238 DOI: 10.1016/j.neucli.2023.102855] [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: 03/03/2023] [Accepted: 03/05/2023] [Indexed: 03/27/2023] Open
Abstract
The evaluation of the autonomic reactivity of newborns by heart rate variability (HRV) analysis is a simple and essential aid to identifying pathological situations of dysautonomia. Thanks to this relatively simple and reproducible analytic tool, the pediatrician can identify and target children at high risk of life-threatening events, i.e., those with insufficient intrinsic capacity for cardiorespiratory self-regulation, who should benefit from close cardiorespiratory monitoring. Different mathematical algorithms integrate delayed or real-time variations in the length of the RR interval to better understand the state of autonomic maturation of the newborn. HRV analysis, as a non-invasive tool for assessing autonomic balance, is essential to assess the functioning of the autonomic nervous system and, more specifically, parasympathetic/sympathetic balance. Despite many recognized diagnostic and therapeutic implications, its application to neonatal medicine is not yet well understood.
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Affiliation(s)
- Hugues Patural
- Neonatal and Pediatric Intensive Care Unit, Centre Hospitalier Universitaire de Saint-Étienne, F-42023, Saint-Étienne, France; Université Jean Monnet Saint-Étienne, INSERM, SAINBIOSE U1059, F-42023, Saint-Étienne, France.
| | - Vincent Pichot
- Université Jean Monnet Saint-Étienne, INSERM, SAINBIOSE U1059, F-42023, Saint-Étienne, France
| | - Frédéric Roche
- Université Jean Monnet Saint-Étienne, INSERM, SAINBIOSE U1059, F-42023, Saint-Étienne, France
| | - Antoine Giraud
- Neonatal and Pediatric Intensive Care Unit, Centre Hospitalier Universitaire de Saint-Étienne, F-42023, Saint-Étienne, France; Université Jean Monnet Saint-Étienne, INSERM, SAINBIOSE U1059, F-42023, Saint-Étienne, France
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Dynamic touch induces autonomic changes in preterm infants as measured by changes in heart rate variability. Brain Res 2023; 1799:148169. [PMID: 36410429 DOI: 10.1016/j.brainres.2022.148169] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 08/29/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022]
Abstract
Preterm birth significantly increases the risk of developing various long-term health problems and developmental disabilities. While touch is a crucial component of many perinatal care strategies, the neurobiological underpinnings are rarely considered. C-tactile fibers (CTs) are unmyelinated nerve fibers that are activated by low-force, dynamic touch. Touch directed specifically at CTs activates the posterior insular cortex, consistent with an interoceptive function, and has been shown to reduce heart rate and increase oxygen saturation. The current research compared the effect of five minutes of CT optimal velocity stroking touch versus five minutes of static touch on autonomic markers of preterm infants between 28 and 37 weeks gestational age. CT touch induces a higher increase in heart rate variability metrics related to the parasympathetic system, which persisted for a 5-minute post-touch period. Conversely, there was no such increase in infants receiving static touch. The present findings confirmed that CTs signal the affective quality of nurturing touch, thereby arguing an additional neurobiological substrate for the evident valuable impacts of neonatal tactile interventions and improving the effectiveness of such interventions.
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Bachiller Carnicero L, Antoñón Rodríguez M, de la Huerga López A, Martín Ramos S, Morales Luengo F, Marín Urueña SI, Caserío Carbonero S. Parasympathetic evaluation for procedural pain assessment in neonatology. An Pediatr (Barc) 2022; 97:390-397. [PMID: 36241543 DOI: 10.1016/j.anpede.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/02/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The Newborn Infant Parasympathetic Evaluation (NIPE) index is an instrument that enables continuous, fast and objective assessment of neonatal discomfort. The aim of the study was to analyse changes in NIPE values after performance of blood draws and the factors involved in this variation. MATERIAL AND METHODS We conducted a prospective observational study. We included infants admitted to the neonatal intensive care unit between June and December 2021 who underwent blood draws. We recorded demographic data, aspects related to the procedure, the NIPE index and the heart rate at baseline and 1, 2, 3, 4, 5, 10 and 15 min after the procedure. RESULTS The study included 86 records for 49 patients. In the first 4 min after the procedure, there was a significant decrease in the NIPE index, with a maximum decrease of 22.8% relative to baseline and the nadir at 2.79 min. The decrease in NIPE values was greater in infants born preterm, male, with lower 5-min Apgar scores and following procedures that had been performed previously, after caesarean section or in the morning. There were no differences when the blood draw was obtained during kangaroo care. The correlation between the NIPE index and the heart rate was weak. CONCLUSIONS After a painful procedure, such as a blood draw, the NIPE monitor showed a significant decrease in the first 4 min, which was more pronounced in preterm infants, in repeated procedures or after caesarean delivery. The NIPE index could help identify infants experiencing acute procedural pain, complementing clinical rating scales.
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Affiliation(s)
| | | | | | - Silvia Martín Ramos
- Unidad de Neonatología, Hospital Universitario Río Hortega, Valladolid, Spain
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Neuromonitoring in neonatal critical care part II: extremely premature infants and critically ill neonates. Pediatr Res 2022:10.1038/s41390-022-02392-2. [PMID: 36434203 DOI: 10.1038/s41390-022-02392-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 11/27/2022]
Abstract
Neonatal intensive care has expanded from cardiorespiratory care to a holistic approach emphasizing brain health. To best understand and monitor brain function and physiology in the neonatal intensive care unit (NICU), the most commonly used tools are amplitude-integrated EEG, full multichannel continuous EEG, and near-infrared spectroscopy. Each of these modalities has unique characteristics and functions. While some of these tools have been the subject of expert consensus statements or guidelines, there is no overarching agreement on the optimal approach to neuromonitoring in the NICU. This work reviews current evidence to assist decision making for the best utilization of these neuromonitoring tools to promote neuroprotective care in extremely premature infants and in critically ill neonates. Neuromonitoring approaches in neonatal encephalopathy and neonates with possible seizures are discussed separately in the companion paper. IMPACT: For extremely premature infants, NIRS monitoring has a potential role in individualized brain-oriented care, and selective use of aEEG and cEEG can assist in seizure detection and prognostication. For critically ill neonates, NIRS can monitor cerebral perfusion, oxygen delivery, and extraction associated with disease processes as well as respiratory and hypodynamic management. Selective use of aEEG and cEEG is important in those with a high risk of seizures and brain injury. Continuous multimodal monitoring as well as monitoring of sleep, sleep-wake cycling, and autonomic nervous system have a promising role in neonatal neurocritical care.
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Zizzo AR, Hansen J, Peteren OB, Mølgaard H, Uldbjerg N, Kirkegaard I. Growth-restricted human fetuses have preserved respiratory sinus arrhythmia but reduced heart rate variability estimates of vagal activity during quiescence. Physiol Rep 2022; 10:e15458. [PMID: 36411966 PMCID: PMC9812234 DOI: 10.14814/phy2.15458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/17/2022] [Accepted: 08/21/2022] [Indexed: 11/23/2022] Open
Abstract
The aim was to assess the association between fetal growth restriction (FGR) and fetal heart rate variability (FHRV) in relation to fetal movements. A prospective observational cohort study was performed. Non-invasive fetal electrocardiography (NI-FECG) allowed beat-to-beat assessments with <5% corrections of RR intervals. FHRV analyses included: Root mean square of successive RR interval differences (RMSSD), high frequency power (HF power), and low frequency power (LF power). Fetal movements were categorized by continuous ultrasound scanning. We enrolled 36 singleton pregnant women expecting a small fetus (< the 2.3 percentile of mean weight for gestational age) diagnosed by ultrasound, of whom 25 presented with a birthweight < the 2.3 percentile. Among these, 11 were excluded due to low quality NI-FECG recordings, leaving 14 women with 28 recordings eligible for inclusion in the analyses. The control group consisted of 22 healthy fetuses with birthweights between the 10th and the 90th percentile (average for gestational age [AGA]). In FGR fetuses the HRV response to respiratory activity was comparable to that of AGA fetuses. RMSSD (Ratio 1.54 [95% CI: 1.33; 1.79]) and HF power (Ratio 2.88 [95% CI: 2.12; 3.91]) increased, whereas LF/HF power (Ratio: 0.44 [95% CI: 0.31;0.63]) decreased. However, during fetal quiescence, FGR fetuses differed significantly from AGA fetuses. Compared to AGA fetuses, FGR fetuses displayed lower RMSSD (Ratio 0.77 (95% CI: 0.58; 1.02)) and HF power (Ratio 0.56 (95% CI:0.32; 0.98)). This reduction was associated with the severity of the FGR. In conclusion, FGR fetuses displayed a respiratory sinus arrhythmia (RSA) comparable to AGA fetuses; however, more important, parameters representing cardiac vagal activity were impaired in FGR fetuses during quiescence. RSA may constitute an intrinsic function of the cardiovascular system, which is unaffected by fetal compromise. However, the basic cardiac outflow assessed during fetal quiescence indicates a suppressed cardiac vagal activity in the FGR fetuses.
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Affiliation(s)
- Anne Rahbek Zizzo
- Department of Obstetrics and GynaecologyAarhus University HospitalAarhus NDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - John Hansen
- Department of Health Science and TechnologyAalborg UniversityAalborgDenmark
| | - Olav Bjørn Peteren
- Department of ObstetricsCopenhagen University HospitalCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Henning Mølgaard
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of CardiologyAarhus University HospitalAarhus NDenmark
| | - Niels Uldbjerg
- Department of Obstetrics and GynaecologyAarhus University HospitalAarhus NDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Ida Kirkegaard
- Department of Obstetrics and GynaecologyAarhus University HospitalAarhus NDenmark
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Bachiller Carnicero L, Antoñón Rodríguez M, de la Huerga López A, Martín Ramos S, Morales Luengo F, Marín Urueña SI, Caserío Carbonero S. Evaluación del sistema parasimpático durante procedimientos dolorosos en neonatología. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Splanchnic oxygen saturation during reoxygenation with 21% or 100% O 2 in newborn piglets. Pediatr Res 2022; 92:445-452. [PMID: 34725499 DOI: 10.1038/s41390-021-01819-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Increasing evidence recognizes the harm of excess oxygen to lungs, eyes, and brain of preterm infants, but not yet to the intestine. We assessed changes in splanchnic oxygenation during reoxygenation with 21% compared to 100% O2 in a newborn piglet model of perinatal asphyxia. METHODS We randomized 25 piglets to control or intervention. Intervention groups underwent global hypoxia until acidosis and hypotension occurred. Piglets were reoxygenated for 30 min with 21% or 100% O2 and observed for 9 h. We continuously measured regional splanchnic oxygen saturation (rsSO2) using near-infrared spectroscopy (NIRS). We calculated mean rsSO2 and rsCoVar (as SD/mean). We measured PaO2 and SaO2, sampled from the right carotid artery. RESULTS Reoxygenation after global hypoxia restored rsSO2. Reoxygenation with 100% O2 increased rsSO2 to values significantly higher than baseline. In intervention groups, rsCoVar decreased during observation compared to baseline. We found a correlation between rsSO2 and PaO2 (r = 0.420, P < 0.001) and between rsSO2 and SaO2 (r = 0.648, P < 0.001) in pooled data from the entire experiment. CONCLUSION Reoxygenation after global hypoxia improves splanchnic oxygenation, but is associated with reduced variability of rsSO2. Reoxygenation with 100% O2 exposes the intestine to hyperoxia. Splanchnic NIRS is able to detect intestinal hypoxia and hyperoxia. IMPACT Splanchnic oxygenation improves during reoxygenation after global hypoxia, though reoxygenation with 100% O2 exposes the intestine to hyperoxia. Decreased variability of splanchnic oxygenation several hours after hypoxia and reoxygenation seems to be independent of the resuscitation strategy, and may indicate intestinal injury. Splanchnic NIRS monitoring was able to detect intestinal hypoxia and exposure to hyperoxia, as evidenced by a strong correlation between splanchnic oxygenation and arterial oxygen content.
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Manzotti A, Cerritelli F, Lombardi E, Monzani E, Savioli L, Esteves JE, Galli M, La Rocca S, Biasi P, Chiera M, Lista G. Osteopathic Manipulative Treatment Regulates Autonomic Markers in Preterm Infants: A Randomized Clinical Trial. Healthcare (Basel) 2022; 10:813. [PMID: 35627950 PMCID: PMC9141319 DOI: 10.3390/healthcare10050813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 11/24/2022] Open
Abstract
Osteopathic manipulative treatment (OMT) has been found to be effective in the context of premature infants. Nonetheless, no studies have investigated the immediate effects of OMT on heart rate variability (HRV). As altered HRV reflects poor or worsening newborn's clinical conditions and neurodevelopment, should OMT improve HRV fluctuations, it could become a relevant intervention for improving the care of preterm newborns. Therefore, this study aimed to evaluate whether OMT could affect HRV. The study was carried out at the Buzzi Hospital in Milan. From the neonatal intensive care unit, ninety-six preterm infants (41 males) were enrolled and were randomly assigned to one of two treatment groups: OMT or Static Touch. The infants were born at 33.5 weeks (±4.3) and had a mean birth weight of 2067 g (±929). The study had as primary outcome the change in the beat-to-beat variance in heart rate measured through root mean square of consecutive RR interval differences (RMSSD); other metrics were used as secondary and exploratory analyses. Despite the lack of statistically significant results regarding the primary outcomeand some study limitations, compared to static touch, OMT seemed to favor a parasympathetic modulation and improved HRV, which could reflect improvement in newborn's clinical conditions and development.
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Affiliation(s)
- Andrea Manzotti
- RAISE Lab, Foundation COME Collaboration, 65121 Pescara, Italy; (A.M.); (E.L.); (E.M.); (L.S.); (J.E.E.); (M.G.); (S.L.R.); (P.B.); (M.C.)
- Division of Neonatology, “V. Buzzi” Children’s Hospital, ASST-FBF-Sacco, 20157 Milan, Italy;
- Research Department, SOMA, Istituto Osteopatia Milano, 20126 Milan, Italy
| | - Francesco Cerritelli
- RAISE Lab, Foundation COME Collaboration, 65121 Pescara, Italy; (A.M.); (E.L.); (E.M.); (L.S.); (J.E.E.); (M.G.); (S.L.R.); (P.B.); (M.C.)
| | - Erica Lombardi
- RAISE Lab, Foundation COME Collaboration, 65121 Pescara, Italy; (A.M.); (E.L.); (E.M.); (L.S.); (J.E.E.); (M.G.); (S.L.R.); (P.B.); (M.C.)
- Research Department, SOMA, Istituto Osteopatia Milano, 20126 Milan, Italy
| | - Elena Monzani
- RAISE Lab, Foundation COME Collaboration, 65121 Pescara, Italy; (A.M.); (E.L.); (E.M.); (L.S.); (J.E.E.); (M.G.); (S.L.R.); (P.B.); (M.C.)
| | - Luca Savioli
- RAISE Lab, Foundation COME Collaboration, 65121 Pescara, Italy; (A.M.); (E.L.); (E.M.); (L.S.); (J.E.E.); (M.G.); (S.L.R.); (P.B.); (M.C.)
| | - Jorge E. Esteves
- RAISE Lab, Foundation COME Collaboration, 65121 Pescara, Italy; (A.M.); (E.L.); (E.M.); (L.S.); (J.E.E.); (M.G.); (S.L.R.); (P.B.); (M.C.)
- Research Department, Malta ICOM Educational, GZR 1071 Gzira, Malta
| | - Matteo Galli
- RAISE Lab, Foundation COME Collaboration, 65121 Pescara, Italy; (A.M.); (E.L.); (E.M.); (L.S.); (J.E.E.); (M.G.); (S.L.R.); (P.B.); (M.C.)
- Research Department, SOMA, Istituto Osteopatia Milano, 20126 Milan, Italy
| | - Simona La Rocca
- RAISE Lab, Foundation COME Collaboration, 65121 Pescara, Italy; (A.M.); (E.L.); (E.M.); (L.S.); (J.E.E.); (M.G.); (S.L.R.); (P.B.); (M.C.)
- Research Department, SOMA, Istituto Osteopatia Milano, 20126 Milan, Italy
| | - Pamela Biasi
- RAISE Lab, Foundation COME Collaboration, 65121 Pescara, Italy; (A.M.); (E.L.); (E.M.); (L.S.); (J.E.E.); (M.G.); (S.L.R.); (P.B.); (M.C.)
- Research Department, SOMA, Istituto Osteopatia Milano, 20126 Milan, Italy
| | - Marco Chiera
- RAISE Lab, Foundation COME Collaboration, 65121 Pescara, Italy; (A.M.); (E.L.); (E.M.); (L.S.); (J.E.E.); (M.G.); (S.L.R.); (P.B.); (M.C.)
| | - Gianluca Lista
- Division of Neonatology, “V. Buzzi” Children’s Hospital, ASST-FBF-Sacco, 20157 Milan, Italy;
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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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22
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Characterisation of neonatal cardiac dynamics using ordinal partition network. Med Biol Eng Comput 2022; 60:829-842. [PMID: 35119556 DOI: 10.1007/s11517-021-02481-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
The maturation of the autonomic nervous system (ANS) starts in the gestation period and it is completed after birth in a variable time, reaching its peak in adulthood. However, the development of ANS maturation is not entirely understood in newborns. Clinically, the ANS condition is evaluated with monitoring of gestational age, Apgar score, heart rate, and by quantification of heart rate variability using linear methods. Few researchers have addressed this problem from the perspective nonlinear data analysis. This paper proposes a new data-driven methodology using nonlinear time series analysis, based on complex networks, to classify ANS conditions in newborns. We map 74 time series given by RR intervals from premature and full-term newborns to ordinal partition networks and use complexity quantifiers to discriminate the dynamical process present in both conditions. We obtain three complexity quantifiers (permutation, conditional, and global node entropies) using network mappings from forward and reverse directions, and considering different time lags and embedding dimensions. The results indicate that time asymmetry is present in the data of both groups and the complexity quantifiers can differentiate the groups analysed. We show that the conditional and global node entropies are sensitive for detecting subtle differences between the neonates, particularly for small embedding dimensions (m < 7). This study reinforces the assessment of nonlinear techniques for RR interval time series analysis. Graphical Abstract.
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Maternal Singing but Not Speech Enhances Vagal Activity in Preterm Infants during Hospitalization: Preliminary Results. CHILDREN 2022; 9:children9020140. [PMID: 35204861 PMCID: PMC8869818 DOI: 10.3390/children9020140] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/01/2022] [Accepted: 01/12/2022] [Indexed: 11/18/2022]
Abstract
Background: Early parental interventions in the Neonatal Intensive Care Units (NICUs) have beneficial effects on preterm infants’ short and long-term outcomes. The aim of this study was to investigate the effects of Early Vocal Contact (EVC)—singing and speaking—on preterm infants’ vagal activity and autonomic nervous system (ANS) maturation. Methods: In this multi-center randomized clinical trial, twenty-four stable preterm infants, born at 25–32 weeks gestational age, were randomized to either the EVC group or control group, where mothers did not interact with the babies but observed their behavior. Heart Rate Variability (HRV) was acquired before intervention (pre-condition), during vocal contact, and after it (post condition). Results: No significant effect of the vocal contact, singing and speaking, was found in HRV when the intervention group was compared to the control group. However, a significant difference between the singing and the pre and post conditions, respectively, preceding and following the singing intervention, was found in the Low and High Frequency power nu, and in the low/high frequency features (p = 0.037). By contrast, no significant effect of the speaking was found. Conclusions: Maternal singing, but not speaking, enhances preterm infants’ vagal activity in the short-term, thus improving the ANS stability. Future analyses will investigate the effect of enhanced vagal activity on short and long-term developmental outcomes of preterm infants in the NICU.
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Kalteren WS, Bos AF, van Oeveren W, Hulscher JBF, Kooi EMW. Neonatal anemia relates to intestinal injury in preterm infants. Pediatr Res 2022; 91:1452-1458. [PMID: 34907357 PMCID: PMC8670618 DOI: 10.1038/s41390-021-01903-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/03/2021] [Accepted: 11/26/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Anemia is associated with decreased tissue oxygenation in preterm infants and may contribute to developing necrotizing enterocolitis (NEC). We aimed to investigate whether hemoglobin level is associated with intestinal injury, by comparing anemic infants 10 days prior to red blood cell (RBC) transfusion with non-anemic controls. METHODS A nested case-control study in which we matched anemic preterms (gestational age (GA) < 32 weeks) with non-anemic controls (1:1), based on GA, birth weight (BW), and postnatal age. We measured urinary intestinal fatty acid-binding protein, I-FABP, marker for intestinal injury, twice weekly. Simultaneously, we assessed splanchnic oxygen saturation (rsSO2) and rsSO2 variability. RESULTS Thirty-six cases and 36 controls were included (median GA 27.6 weeks, BW 1020 grams). Median I-FABP level was higher in cases from 6 days to 24-h before transfusion (median ranging: 4749-8064 pg/ml versus 2194-3751 pg/ml). RsSO2 and rsSO2 variability were lower in cases than controls shortly before transfusion. Hemoglobin levels correlated negatively with rsSO2 and rsSO2 variability in cases, and negatively with I-FABP in cases and controls together. CONCLUSIONS Urinary I-FABP levels were higher in anemic infants before RBC transfusion than in non-anemic matched controls, suggesting intestinal injury associated with anemia. This may predispose to NEC in some anemic preterm infants. IMPACT Anemia is a common comorbidity in preterm infants and may lead to impaired splanchnic oxygen saturation and intestinal tissue hypoxia, a proposed mechanism for NEC. Lower hemoglobin level is associated with higher urinary I-FABP levels, a marker for intestinal injury, both in anemic preterm infants and in cases and controls together. Lower splanchnic oxygen saturation and reduction of its variability are associated with higher urinary I-FABP levels in anemic preterm infants before their first RBC transfusion. These results support the hypothesis that anemia in very preterm infants results in intestinal cell injury, which may precede NEC development in some.
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Affiliation(s)
- Willemien S. Kalteren
- grid.4494.d0000 0000 9558 4598Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arend F. Bos
- grid.4494.d0000 0000 9558 4598Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Jan B. F. Hulscher
- grid.4494.d0000 0000 9558 4598Division of Pediatric Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth M. W. Kooi
- grid.4494.d0000 0000 9558 4598Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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25
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AIM in Neonatal and Pediatric Intensive Care. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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26
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Early recognition of neonatal sepsis using a bioinformatic vital sign monitoring tool. Pediatr Res 2022; 91:270-272. [PMID: 34716420 DOI: 10.1038/s41390-021-01829-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 12/31/2022]
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Niemuth M, Küster H, Simma B, Rozycki H, Rüdiger M, Solevåg AL. A critical appraisal of tools for delivery room assessment of the newborn infant. Pediatr Res 2021:10.1038/s41390-021-01896-7. [PMID: 34969993 DOI: 10.1038/s41390-021-01896-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/19/2021] [Indexed: 11/09/2022]
Abstract
Assessment of an infant's condition in the delivery room represents a prerequisite to adequately initiate medical support. In her seminal paper, Virginia Apgar described five parameters to be used for such an assessment. However, since that time maternal and neonatal care has changed; interventions were improved and infants are even more premature. Nevertheless, the Apgar score is assigned to infants worldwide but there are concerns about low interobserver reliability, especially in preterm infants. Also, resuscitative interventions may preclude the interpretation of the score, which is of concern when used as an outcome parameter in delivery room intervention studies. Within the context of these changes, we performed a critical appraisal on how to assess postnatal condition of the newborn including the clinical parameters of the Apgar score, as well as selected additional parameters and a proposed new scoring system. The development of a new scoring system that guide clinicians in assessing infants and help to decide how to support postnatal adaptation is discussed. IMPACT: This critical paper discusses the reliability of the Apgar score, as well as additional parameters, in order to improve assessment of a newborn's postnatal condition. A revised neonatal scoring system should account for infant maturity and the interventions administered. Delivery room assessment should be directed toward determining how much medical support is needed and how the infant responds to these interventions.
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Affiliation(s)
- Mara Niemuth
- Department for Neonatology and Pediatric Intensive Care, Clinic for Pediatric and Adolescence Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Helmut Küster
- Clinic for Pediatric Cardiology, Intensive Care and Neonatology, University Medical Center Göttingen, Göttingen, Germany
| | - Burkhard Simma
- Department of Paediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Henry Rozycki
- Division of Neonatal Medicine, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, VA, USA
| | - Mario Rüdiger
- Department for Neonatology and Pediatric Intensive Care, Clinic for Pediatric and Adolescence Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Saxony Center for Feto-Neonatal Health, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Anne Lee Solevåg
- The Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.
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Preterm infant heart rate is lowered after Family Nurture Intervention in the NICU: Evidence in support of autonomic conditioning. Early Hum Dev 2021; 161:105455. [PMID: 34517207 DOI: 10.1016/j.earlhumdev.2021.105455] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/17/2021] [Accepted: 08/24/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cardiac complications after premature birth are associated with negative long-term consequences to health. The Family Nurture Intervention (FNI) has been designed to support mother-infant parasympathetic calming sessions in the neonatal intensive care unit (NICU). FNI has shown neurodevelopmental and autonomic benefit across infant development. AIMS We tested the hypothesis that heart rate (HR) will decrease after FNI over the course of the NICU stay, compared to matched controls. STUDY DESIGN We used a case-matched design. The intervention included on average four ~1-hour facilitated mother-infant 'calming' sessions per week. We collected 24/7 real time heart rate data from a central monitoring system and analyzed data from two time-periods. SUBJECTS The intervention group comprised 37 infants born ~30 weeks gestational age (GA) in a level IV NICU, treated with FNI. From the same NICU and time-period, we created a contemporaneous comparison group of 32 infants who were case-matched to each intervention infant for sex, age-at-birth, singleton or twin status, month of admission and length of stay. OUTCOME MEASURES Using generalized estimating equation (GEE) modeling, we analyzed 24/7 HR data during a 1-hour period between 4:30 and 5:30 am each day in the NICU, when all infants were least disturbed. Using repeated measures ANOVA, we analyzed 24/7 HR data during a 6-week period starting 1 week prior to the start of FNI and ending 5 weeks after start. RESULTS GEE modeling of the 1-hour data from all subjects showed significant lower HR in the FNI group, compared with controls. ANOVA modeling on a subset of subjects over the five-week period showed that FNI infant HR decreased in a dose-response manner relative to SC HR. CONCLUSION This study suggests FNI may condition lower infant HR in a dose-response manner during the NICU stay.
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29
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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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30
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Hasegawa Y, Hoshiyama M. Effect of environmental music on autonomic function in infants in intensive and growing care units. J Neonatal Perinatal Med 2021; 13:395-401. [PMID: 31771074 DOI: 10.3233/npm-180174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The aim of this study is (1) to observe the effect of the background music (BGM) in the incubator on heart rate variability (HRV) during the first few weeks of life in preterm infants in the neonatal intensive (NICU) and growing care units (GCU) and (2) to investigate the effect of environmental music on autonomic function in the infants. METHODS Thirty infants, including premature (26 3/7 - 38 4/7 weeks) and low-birth weight (LBW) (946-2,440 g) infants, admitted to the NICU or GCU were involved. The heart rate, low- (LF, 0.05-0.15 Hz) and high- (HF, 0.15-0.4 Hz) frequency HRV components, and LF/HF ratio were measured. The BGM, lullabies for a baby, was delivered through a speaker in the incubator, and the HRV components were compared among before, during, and after intervention with BGM. RESULTS The mean HR did not change among the experimental conditions. The LF and HF values decreased during the BGM condition, but not LF/HF, compared with the condition before BGM. CONCLUSIONS The present results showed that an auditory environment affected the autonomic function of infants with a range of BGM in the NICU/GCU. The present study also suggested that BGM, a non-invasive and non-pharmacological intervention, could be an evaluation tool for autonomic function in infants in NICU/GCU.
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Affiliation(s)
- Y Hasegawa
- Department of Rehabilitation Sciences, Graduate School of Health Sciences, Nagoya University, Nagoya, Japan
| | - M Hoshiyama
- Brain and Mind Research Center, Nagoya University, Higashi-ku, Nagoya, Japan
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31
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Kamiya C, Miyake A, Yamada T, Ohmi M, Watanabe H. The effects of massage velocity on heart rate and heart rate variability in healthy infants: A randomized crossover study. Infant Behav Dev 2021; 64:101604. [PMID: 34274848 DOI: 10.1016/j.infbeh.2021.101604] [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: 01/12/2021] [Revised: 06/09/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Infant massage, in which mothers stroke their infant's skin slowly and gently, can cause pleasant sensations in the infant that can be affected by the velocity of massage. However, the massage velocity at which infants feel the most pleasant sensations remains unclear. OBJECTIVE To investigate the effects of massage velocity on heart rate (HR) and HR variability (HRV) in healthy infants. METHOD Twenty-two infant-mother dyads two to seven months of age were recruited. Mothers stroked their infant's skin at three massage velocities (5.0, 7.5, and 10.0 cm/s) in a randomized order for 15 min. The rhythm of massage velocity was calculated according to the length of three body areas. The massage velocity of the mothers was regulated using a metronome. HR and HRV (high frequency [HF] and low frequency [LF]) were measured at rest and during massage for each velocity. The effects on pleasantness were evaluated using percent change in median baseline value compared with median values for the three massage velocities. Statistical analysis was performed using analysis of variance mixed effect models to exclude "period" and "carryover" effects during massage. RESULTS When measuring HF, massage (7.5 cm/s) caused a significant increase in pleasantness compared with 10.0 cm/s (p = 0.04). The HR and LF/HF ratio were not significantly changed between velocities. CONCLUSION Results of this study suggested that a massage velocity of 7.5 cm/s was the most pleasant for infants. Future research should investigate the relationship between an infant massage by optimal velocity and infant development in longitudinal studies.
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Affiliation(s)
- Chiori Kamiya
- Division of Developmental Neuroscience, United Graduate School of Child Development, Osaka University, Osaka, Japan
| | - Akimitsu Miyake
- Department of Medical Innovation, Osaka University Hospital, Osaka, Japan
| | - Tomomi Yamada
- Department of Medical Innovation, Osaka University Hospital, Osaka, Japan
| | - Masato Ohmi
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroko Watanabe
- Department of Children and Women's Health, Osaka University Graduate School of Medicine, Osaka, Japan.
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32
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Sbrollini A, Mancinelli M, Marcantoni I, Morettini M, Carnielli VP, Burattini L. Adaptive bradycardia assessment in preterm infants. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Herry CL, Soares HMF, Schuler-Faccini L, Frasch MG. Machine learning model on heart rate variability metrics identifies asymptomatic toddlers exposed to zika virus during pregnancy. Physiol Meas 2021; 42. [PMID: 33984844 DOI: 10.1088/1361-6579/ac010e] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/13/2021] [Indexed: 12/27/2022]
Abstract
Objective. Although the Zika virus (ZIKV) seems to be prominently neurotropic, there are some reports of involvement of other organs, particularly the heart. Of special concern are those children exposed prenatally to ZIKV and born without microcephaly or other congenital anomalies. Electrocardiogram (ECG)-derived heart rate variability (HRV) metrics represent an attractive, low-cost, widely deployable tool for early identification of developmental functional alterations in exposed children born without such overt clinical symptoms. We hypothesized that HRV in such children would yield a biomarker of fetal ZIKV exposure. Our objective was to test this hypothesis in young children exposed to ZIKV during pregnancy.Approach. We investigated the HRV properties of 21 children aged 4-25 months from Brazil. The infants were divided into two groups, the ZIKV-exposed (n = 13) and controls (n = 8). Single-channel ECG was recorded in each child at ∼15 months of age and HRV was analyzed in 5 min segments to provide a comprehensive characterization of the degree of variability and complexity of the heart rate.Main results.Using a cubic support vector machine classifier we identified babies as Zika cases or controls with a negative predictive value of 92% and a positive predictive value of 86%. Our results show that a machine learning model derived from HRV metrics can help differentiate between ZIKV-affected, yet asymptomatic, and non-ZIKV-exposed babies. We identified the box count as the best HRV metric in this study allowing such differentiation, regardless of the presence of microcephaly.Significance.We show that it is feasible to measure HRV in infants and toddlers using a small non-invasive portable ECG device and that such an approach may uncover the memory ofin uteroexposure to ZIKV. We discuss putative mechanisms. This approach may be useful for future studies and low-cost screening tools involving this challenging to examine population.
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Affiliation(s)
| | - Helena M F Soares
- INAGEMP-Departamento de Genética-Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Brazil
| | - Lavinia Schuler-Faccini
- INAGEMP-Departamento de Genética-Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Brazil
| | - Martin G Frasch
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America
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Masumoto K, Kusuda S. Hemodynamic support of the micropreemie: Should hydrocortisone never be left out? Semin Fetal Neonatal Med 2021; 26:101222. [PMID: 33692008 DOI: 10.1016/j.siny.2021.101222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hemodynamic support for a micropreemie is critically important for preventing mortality and morbidity. An essential consideration in hemodynamic support is insufficient transition from fetal to neonatal circulation and inadequate cortisol production. The first 72 h of life are the most critical, especially when myocardial function is immature and impaired. Therefore, there is a need to determine and adjust preload, myocardial contractility, and afterload appropriately using repeated functional echocardiography. In addition, if myocardial function is not responsive to these attempts at hemodynamic management, hydrocortisone must be used to minimize the suboptimal perfusion burden. Fetal cortisol production is supported by a supply of progesterone from the placenta, and postnatally, adrenal cortisol production in the extremely preterm infant may be inadequate if the infant is placed under excessive stress. This leads to relative adrenal insufficiency which may last for up to several weeks after birth and lead to late-onset circulatory collapse, necessitating treatment with physiological doses of hydrocortisone.
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Affiliation(s)
- Kenichi Masumoto
- Department of Neonatology, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Satoshi Kusuda
- Department of Pediatrics, Kyorin University, Tokyo, Japan.
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Lavanga M, Bollen B, Caicedo A, Dereymaeker A, Jansen K, Ortibus E, Van Huffel S, Naulaers G. The effect of early procedural pain in preterm infants on the maturation of electroencephalogram and heart rate variability. Pain 2021; 162:1556-1566. [PMID: 33110029 PMCID: PMC8054544 DOI: 10.1097/j.pain.0000000000002125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 01/18/2023]
Abstract
ABSTRACT Preterm infants show a higher incidence of cognitive, social, and behavioral problems, even in the absence of major medical complications during their stay in the neonatal intensive care unit (NICU). Several authors suggest that early-life experience of stress and procedural pain could impact cerebral development and maturation resulting in an altered development of cognition, behavior, or motor patterns in later life. However, it remains very difficult to assess this impact of procedural pain on physiological development. This study describes the maturation of electroencephalogram (EEG) signals and heart rate variability in a prospective cohort of 92 preterm infants (<34 weeks gestational age) during their NICU stay. We took into account the number of noxious, ie, skin-breaking, procedures they were subjected in the first 5 days of life, which corresponded to a median age of 31 weeks and 4 days. Using physiological signal modelling, this study shows that a high exposure to early procedural pain, measured as skin-breaking procedures, increased the level of discontinuity in both EEG and heart rate variability in preterm infants. These findings have also been confirmed in a subset of the most vulnerable preterm infants with a gestational age lower than 29 weeks. We conclude that a high level of early pain exposure in the NICU increases the level of functional dysmaturity, which can ultimately impact preterm infants' future developmental outcome.
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Affiliation(s)
- Mario Lavanga
- Department of Electrical Engineering (ESAT), Division STADIUS, KU Leuven, Leuven, Belgium
| | - Bieke Bollen
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Alexander Caicedo
- Department of Applied Mathematics and Computer Science, School of Engineering, Science and Technology, Universidad Del Rosario, Bogota', Colombia
| | - Anneleen Dereymaeker
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Katrien Jansen
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Els Ortibus
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Sabine Van Huffel
- Department of Electrical Engineering (ESAT), Division STADIUS, KU Leuven, Leuven, Belgium
| | - Gunnar Naulaers
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
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Bersani I, Piersigilli F, Gazzolo D, Campi F, Savarese I, Dotta A, Tamborrino PP, Auriti C, Di Mambro C. Heart rate variability as possible marker of brain damage in neonates with hypoxic ischemic encephalopathy: a systematic review. Eur J Pediatr 2021; 180:1335-1345. [PMID: 33245400 PMCID: PMC7691422 DOI: 10.1007/s00431-020-03882-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/18/2020] [Accepted: 11/18/2020] [Indexed: 12/20/2022]
Abstract
Heart rate variability (HRV) is currently considered the most valuable non-invasive test to investigate the autonomic nervous system function, based on the fact that fast fluctuations might specifically reflect changes of sympathetic and vagal activity. An association between abnormal values of HRV and brain impairment has been reported in the perinatal period, although data are still fragmentary. Considering such association, HRV has been suggested as a possible marker of brain damage also in case of hypoxic-ischemic encephalopathy following perinatal asphyxia. The aim of the present manuscript was to review systematically the current knowledge about the use of HRV as marker of cerebral injury in neonates suffering from hypoxic-ischemic encephalopathy. Findings reported in this paper were based on qualitative analysis of the reviewed data. Conclusion: A growing body of research supports the use of HRV as non-invasive, bedside tool for the monitoring of hypoxic-ischemic encephalopathy. The currently available data about the role of HRV as prognostic tool in case of hypoxic ischemic encephalopathy are promising but require further validation by future studies. What is Known: • Heart rate variability (HRV) is a non-invasive monitoring technique to assess the autonomic nervous system activity. • A correlation between abnormal HRV and cerebral injury has been reported in the perinatal period, and HRV has been suggested as possible marker of brain damage in case of hypoxic-ischemic encephalopathy. What is New: • HRV might provide precocious information about the entity of brain injury in asphyxiated neonates and be of help to design early, specific, and personalized treatments according to severity. • Further investigations are required to confirm these preliminary data.
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Affiliation(s)
- Iliana Bersani
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Fiammetta Piersigilli
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Diego Gazzolo
- Neonatal Intensive Care Unit, G. d’Annunzio University, Chieti, Italy
| | - Francesca Campi
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Immacolata Savarese
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Andrea Dotta
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Pietro Paolo Tamborrino
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Complex Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Cinzia Auriti
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Corrado Di Mambro
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Complex Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, Rome, Italy
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Koumarela C, Kokkinaki T, Giannakakis G, Koutra K, Hatzidaki E. Autonomic Nervous System Maturation and Emotional Coordination in Interactions of Preterm and Full-Term Infants With Their Parents: Protocol for a Multimethod Study. JMIR Res Protoc 2021; 10:e28089. [PMID: 33843606 PMCID: PMC8076991 DOI: 10.2196/28089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background There is limited knowledge on the physiological and behavioral pathways that may affect the developmental outcomes of preterm infants and particularly on the link between autonomic nervous system maturation and early social human behavior. Thus, this study attempts to investigate the way heart rate variability (HRV) parameters are related to emotional coordination in interactions of preterm and full-term infants with their parents in the first year of life and the possible correlation with the developmental outcomes of infants at 18 months. Objective The first objective is to investigate the relationship between emotional coordination and HRV in dyadic full-term infant–parent (group 1) and preterm infant–parent (group 2) interactions during the first postpartum year. The second objective is to examine the relationship of emotional coordination and HRV in groups 1 and 2 in the first postpartum year with the developmental outcomes of infants at 18 months. The third objective is to investigate the effect of maternal and paternal postnatal depression on the relation between emotional coordination and HRV in the two groups and on developmental outcomes at 18 months. The fourth objective is to examine the effect of family cohesion and coping on the relation between emotional coordination and HRV in the two groups and on developmental outcomes at 18 months. Methods This is an observational, naturalistic, and longitudinal study applying a mixed method design that includes the following: (1) video recordings of mother-infant and father-infant interactions at the hospital, in the neonatal period, and at home at 2, 4, 6, 9, and 12 months of the infants’ life; (2) self-report questionnaires of parents on depressive symptoms, family cohesion, and dyadic coping of stress; (3) infants’ HRV parameters in the neonatal period and at each of the above age points during and after infant-parent video recordings; and (4) assessment of toddlers’ social and cognitive development at 18 months through an observational instrument. Results The study protocol has been approved by the Research Ethics Committee of the University of Crete (number/date: 170/September 18, 2020). This work is supported by the Special Account for Research Funds of the University of Crete (grant number: 10792-668/08.02.2021). All mothers (with their partners) of full-term and preterm infants who give birth between March 2021 and January 2022 at the General University Hospital of Crete (northern Crete, Greece) will be invited to participate. The researcher will invite the parents of infants to participate in the study 1 to 2 days after birth. Data collection is expected to be completed by March 2023, and the first results will be published by the end of 2023. Conclusions Investigating the regulatory role of HRV and social reciprocity in preterm infants may have implications for both medicine and psychology. International Registered Report Identifier (IRRID) PRR1-10.2196/28089
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Affiliation(s)
- Christina Koumarela
- Laboratory of Applied Psychology, Department of Psychology, University of Crete, Rethymnon, Greece
| | - Theano Kokkinaki
- Laboratory of Applied Psychology, Department of Psychology, University of Crete, Rethymnon, Greece
| | - Giorgos Giannakakis
- Institute of Computer Science, Foundation of Research and Technology, Heraklion, Greece
| | - Katerina Koutra
- Department of Psychology, University of Crete, Rethymnon, Greece
| | - Eleftheria Hatzidaki
- Department of Neonatology, Neonatal Intensive Care Unit, School of Medicine, University of Crete, Heraklion, Greece
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Zhang D, Long X, Xu L, Werth J, Wijshoff R, Aarts RM, Andriessen P. Characterizing cardiorespiratory interaction in preterm infants across sleep states using visibility graph analysis. J Appl Physiol (1985) 2021; 130:1015-1024. [PMID: 33539263 DOI: 10.1152/japplphysiol.00333.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cardiorespiratory interaction (CRI) has been intensively studied in adult sleep, yet not in preterm infants, in particular across different sleep states including wake (W), active sleep (AS), and quiet sleep (QS). The aim of this study was to quantify the interaction between cardiac and respiratory activities in different sleep states of preterm infants. The postmenstrual age (PMA) of preterm infants was also taken into consideration. The CRI during sleep was analyzed using a visibility graph (VG) method, enabling the nonlinear analysis of CRI in a complex network. For each sleep state, parameters quantifying various aspects of the CRI characteristics from constructed VG network including mean degree (Dm) and its variability (Dsd), clustering coefficient (CCm) and its variability (CCsd), assortativity coefficient (AC), and complexity (DSE) were extracted from the CRI networks. The interaction effect of sleep state and PMA was found to be statistically significant on all CRI parameters except for AC and DSE. The main effect between sleep state and CRI parameters was statistically significant except for CCm, and that between PMA and CRI parameters was statistically significant except for DSE. In conclusion, the CRI of preterm infants is associated with sleep states and PMA in general. For preterm infants with a larger PMA, CRI has a more clustered pattern during different sleep states, where QS shows a more regular, stratified, and stronger CRI than other states. In the future, these parameters can be potentially used to separate sleep states in preterm infants.NEW & NOTEWORTHY The interaction between cardiac and respiratory activities is investigated in preterm infant sleep using an advanced nonlinear method (visibility graph) and some important characteristics are shown to be significantly different across sleep states, which has not been studied before.
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Affiliation(s)
- Dandan Zhang
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Philips Research, Eindhoven, The Netherlands
| | - Xi Long
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Philips Research, Eindhoven, The Netherlands
| | - Lin Xu
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Jan Werth
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Ronald M Aarts
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Peter Andriessen
- Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands.,Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands
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de Souza Filho LFM, Martins de Oliveira JC, Silva Rebelo AC. Heart rate variability in the evaluation of the autonomic nervous system of premature infants. Birth Defects Res 2021; 113:872-875. [PMID: 33660936 DOI: 10.1002/bdr2.1885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/14/2021] [Accepted: 02/20/2021] [Indexed: 11/12/2022]
Abstract
One way to analyze the function of the autonomic nervous system (ANS) is through heart rate variability (HRV). This approach is based on the analysis of the distance between the peaks of two consecutive R waves expressed in electrocardiograms. HRV evaluations have been developed and have become more accessible and reliable through technological advances that enable the data collection in a simpler, non-invasive, and reliable way. However, there is little information in the scientific literature on the implementation of this methodology to assess the ANS of preterm infants. In this article, we survey the barriers, potential uses, and other topics regarding the assessment of the ANS in preterm infants using HRV.
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Affiliation(s)
- Luiz Fernando Martins de Souza Filho
- Faculty of Medicine, Department of Health Sciences, Federal University of Goiás, Goiânia, Goiás, Brazil.,Physiotherapy Department, Faculty Estácio de Sá of Goiás, Goiânia, Goiás, Brazil
| | - Jordana Campos Martins de Oliveira
- Faculty of Medicine, Department of Health Sciences, Federal University of Goiás, Goiânia, Goiás, Brazil.,Physiotherapy Department, University Center Araguaia, Goiânia, Goiás, Brazil
| | - Ana Cristina Silva Rebelo
- Faculty of Medicine, Department of Health Sciences, Federal University of Goiás, Goiânia, Goiás, Brazil
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40
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Technical Innovation for Visual Assessment of Preterm Newborns in a Neonatal Intensive Care Unit: Exploratory Study. Rehabil Res Pract 2021; 2021:9837505. [PMID: 33489378 PMCID: PMC7801074 DOI: 10.1155/2021/9837505] [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: 05/14/2020] [Revised: 11/10/2020] [Accepted: 12/19/2020] [Indexed: 11/17/2022] Open
Abstract
Objective The present study is aimed at assessing heart rate variability (HRV) and its correlation with visual acuity (VA) assessment of preterm newborns (PTNB) in neonatal intensive care units. Method Cross-sectional study analyzing HRV during assessment of VA with the aid of a Polar RS800CX heart rate monitor (Polar Electro Oy, Finland). HRV was analyzed according to time and frequency domains and the chaos domain used the autocorrelation coefficient and entropy. The sample consisted of hospitalized PTNB, and static analysis included simple regression diagnosis. Results A total of 14 PTNB were included in the sample. VA varied between 0.23 and 1.60 cpd, and only five PTNB obtained below-expected values for age. Statistical analysis demonstrated a negative correlation between VA and time domain (SDDN and SD2) and a positive correlation between frequency domain (heart rate and hertz), but in simple linear regression analysis, these variables did not influence VA. Conclusion The results of the study demonstrate that visual acuity was inversely correlated with SDNN and SD2 and during stimulation, showing that the higher the visual performance, the lower the autonomic modulation response.
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41
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Lavanga M, Heremans E, Moeyersons J, Bollen B, Jansen K, Ortibus E, Naulaers G, Van Huffel S, Caicedo A. Maturation of the Autonomic Nervous System in Premature Infants: Estimating Development Based on Heart-Rate Variability Analysis. Front Physiol 2021; 11:581250. [PMID: 33584326 PMCID: PMC7873975 DOI: 10.3389/fphys.2020.581250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/02/2020] [Indexed: 11/13/2022] Open
Abstract
This study aims at investigating the development of premature infants' autonomic nervous system (ANS) based on a quantitative analysis of the heart-rate variability (HRV) with a variety of novel features. Additionally, the role of heart-rate drops, known as bradycardias, has been studied in relation to both clinical and novel sympathovagal indices. ECG data were measured for at least 3 h in 25 preterm infants (gestational age ≤32 weeks) for a total number of 74 recordings. The post-menstrual age (PMA) of each patient was estimated from the RR interval time-series by means of multivariate linear-mixed effects regression. The tachograms were segmented based on bradycardias in periods after, between and during bradycardias. For each of those epochs, a set of temporal, spectral and fractal indices were included in the regression model. The best performing model has R 2 = 0.75 and mean absolute error MAE = 1.56 weeks. Three main novelties can be reported. First, the obtained maturation models based on HRV have comparable performance to other development models. Second, the selected features for age estimation show a predominance of power and fractal features in the very-low- and low-frequency bands in explaining the infants' sympathovagal development from 27 PMA weeks until 40 PMA weeks. Third, bradycardias might disrupt the relationship between common temporal indices of the tachogram and the age of the infant and the interpretation of sympathovagal indices. This approach might provide a novel overview of post-natal autonomic maturation and an alternative development index to other electrophysiological data analysis.
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Affiliation(s)
- Mario Lavanga
- Division STADIUS, Department of Electrical Engineering (ESAT), Katholieke Universiteit Leuven, Leuven, Belgium
| | - Elisabeth Heremans
- Division STADIUS, Department of Electrical Engineering (ESAT), Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jonathan Moeyersons
- Division STADIUS, Department of Electrical Engineering (ESAT), Katholieke Universiteit Leuven, Leuven, Belgium
| | - Bieke Bollen
- Department of Development and Regeneration, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Katrien Jansen
- Department of Development and Regeneration, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Els Ortibus
- Department of Development and Regeneration, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Gunnar Naulaers
- Department of Development and Regeneration, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sabine Van Huffel
- Division STADIUS, Department of Electrical Engineering (ESAT), Katholieke Universiteit Leuven, Leuven, Belgium
| | - Alexander Caicedo
- Applied Mathematics and Computer Science, School of Engineering, Science and Technology, Universidad del Rosario, Bogotá, Colombia
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AIM in Neonatal and Paediatric Intensive Care. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-58080-3_309-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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Gleichmann DC, Solis I, Janowich JR, Wang YP, Calhoun VD, Wilson TW, Stephen JM. Troubled Hearts: Association Between Heart Rate Variability and Depressive Symptoms in Healthy Children. Appl Psychophysiol Biofeedback 2020; 45:283-292. [PMID: 32978742 PMCID: PMC8045383 DOI: 10.1007/s10484-020-09488-7] [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] [Accepted: 09/10/2020] [Indexed: 10/23/2022]
Abstract
Heart rate variability (HRV) captures the change in timing of consecutive heart beats and is reduced in individuals with depression and anxiety. The present study investigated whether typically-developing children without clinically recognized signs of depression or anxiety showed a relationship between HRV and depressive or anxiety symptoms. Children aged 9-14 years (N = 104) provided three minutes of cardiac signal during eyes closed rest and eyes open rest. The association between high frequency HRV, low frequency HRV, root mean square of the successive differences (RMSSD), and pNN20 versus depressive symptoms (NIH Toolbox and Child Behavior Checklist) was investigated. Results partially confirm our hypothesis, with pNN20 positively correlated with the self-reported depression measure of loneliness while controlling for age, sex, social status, and physical activity. The association was stronger in male participants. However, there is no consensus in the literature about which HRV measures are associated with depressive symptoms in healthy children. Additional studies are needed which reliably account for variables that influence HRV to establish whether certain HRV measures can be used as an early marker for depression risk in children.
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Affiliation(s)
| | - Isabel Solis
- The Mind Research Network, 1101 Yale Blvd NE, Albuquerque, NM, 87106, USA
| | | | - Yu-Ping Wang
- Tulane University, 6823 St. Charles Ave, New Orleans, LA, 70118, USA
| | - Vince D Calhoun
- The Mind Research Network, 1101 Yale Blvd NE, Albuquerque, NM, 87106, USA
- University of New Mexico, Albuquerque, NM, 87131, USA
| | - Tony W Wilson
- University of Nebraska Medical Center, S 42nd St. & Emile St, Omaha, NE, 68198, USA
| | - Julia M Stephen
- The Mind Research Network, 1101 Yale Blvd NE, Albuquerque, NM, 87106, USA.
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Chiera M, Cerritelli F, Casini A, Barsotti N, Boschiero D, Cavigioli F, Corti CG, Manzotti A. Heart Rate Variability in the Perinatal Period: A Critical and Conceptual Review. Front Neurosci 2020; 14:561186. [PMID: 33071738 PMCID: PMC7544983 DOI: 10.3389/fnins.2020.561186] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/28/2020] [Indexed: 12/18/2022] Open
Abstract
Neonatal intensive care units (NICUs) greatly expand the use of technology. There is a need to accurately diagnose discomfort, pain, and complications, such as sepsis, mainly before they occur. While specific treatments are possible, they are often time-consuming, invasive, or painful, with detrimental effects for the development of the infant. In the last 40 years, heart rate variability (HRV) has emerged as a non-invasive measurement to monitor newborns and infants, but it still is underused. Hence, the present paper aims to review the utility of HRV in neonatology and the instruments available to assess it, showing how HRV could be an innovative tool in the years to come. When continuously monitored, HRV could help assess the baby’s overall wellbeing and neurological development to detect stress-/pain-related behaviors or pathological conditions, such as respiratory distress syndrome and hyperbilirubinemia, to address when to perform procedures to reduce the baby’s stress/pain and interventions, such as therapeutic hypothermia, and to avoid severe complications, such as sepsis and necrotizing enterocolitis, thus reducing mortality. Based on literature and previous experiences, the first step to efficiently introduce HRV in the NICUs could consist in a monitoring system that uses photoplethysmography, which is low-cost and non-invasive, and displays one or a few metrics with good clinical utility. However, to fully harness HRV clinical potential and to greatly improve neonatal care, the monitoring systems will have to rely on modern bioinformatics (machine learning and artificial intelligence algorithms), which could easily integrate infant’s HRV metrics, vital signs, and especially past history, thus elaborating models capable to efficiently monitor and predict the infant’s clinical conditions. For this reason, hospitals and institutions will have to establish tight collaborations between the obstetric, neonatal, and pediatric departments: this way, healthcare would truly improve in every stage of the perinatal period (from conception to the first years of life), since information about patients’ health would flow freely among different professionals, and high-quality research could be performed integrating the data recorded in those departments.
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Affiliation(s)
- Marco Chiera
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy.,Research Commission on Manual Therapies and Mind-Body Disciplines, Societ Italiana di Psico Neuro Endocrino Immunologia, Rome, Italy
| | - Francesco Cerritelli
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Alessandro Casini
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Nicola Barsotti
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy.,Research Commission on Manual Therapies and Mind-Body Disciplines, Societ Italiana di Psico Neuro Endocrino Immunologia, Rome, Italy
| | | | - Francesco Cavigioli
- Neonatal Intensive Care Unit, "V. Buzzi" Children's Hospital, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Milan, Italy
| | - Carla G Corti
- Pediatric Cardiology Unit-Pediatric Department, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Milan, Italy
| | - Andrea Manzotti
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy.,Neonatal Intensive Care Unit, "V. Buzzi" Children's Hospital, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Milan, Italy.,Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
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Wolfsberger C, Baik-Schneditz N, Schwaberger B, Binder-Heschl C, Nina H, Mileder L, Bruckner M, Avian A, Urlesberger B, Pichler G. Changes in peripheral muscle oxygenation measured with near-infrared spectroscopy in preterm neonates within the first 24 h after birth. Physiol Meas 2020; 41:075003. [PMID: 32498045 DOI: 10.1088/1361-6579/ab998b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Near-infrared spectroscopy (NIRS) combined with venous occlusions enables peripheral-muscle oxygenation and perfusion monitoring. OBJECTIVE The aim of the present exploratory observational study was to evaluate peripheral-muscle oxygenation and perfusion during the first 24 h after birth in stable preterm neonates. APPROACH Secondary outcome parameters of prospective observational studies were analysed. Preterm neonates with peripheral-muscle NIRS measurements combined with venous occlusion on the first day after birth were included. Neonates without circulatory support and without signs of infection/inflammation were included. Neonates were stratified in four groups according to their measurement time-point (6 h-periods) and matched 2:1 for gestational age ±1 week. For each group haemoglobin flow (Hbflow), oxygen-delivery (DO2), oxygen-consumption (VO2), fractional-oxygen-extraction (FOE), tissue-oxygenation-index (TOI) and mixed-venous-oxygenation (SvO2) were calculated. Neonates with measurements during the first 6-hour time period were compared to neonates with measurements of the following time periods. MAIN RESULTS 40 preterm neonates (gestational age (median(IQR)): 33.5(32.5-34.1)weeks) measured during the first 6 h period after birth were compared to 20 preterm neonates measured in each of the following 6 h periods (period two: 33.7(33.1-34.3)weeks; period three: 34.1(33.2-34.6)weeks; period four: 33.8(32.6-34.6)weeks). Hbflow, DO2 and SvO2 were significantly higher in the second and third 6 h time period compared to the first 6 h period. VO2 did not change significantly during the first day after birth. FOE was significantly lower in the second, third and fourth time period compared to the first 6 h period. TOI showed a non-significant trend towards higher values in the third period compared to the first 6 h period. SIGNIFICANCE In preterm neonates Hbflow, DO2, SvO2 increased, FOE decreased and TOI showed a trend towards increase during the first day after birth, whereas VO2 did not change. Changes of peripheral-muscle oxygenation during the first day after birth in stable preterm neonates are different to already published changes thereafter.
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Affiliation(s)
- Christina Wolfsberger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria. Research Unit for Neonatal Micro- and Macrocirculation, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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Manzotti A, Cerritelli F, Lombardi E, La Rocca S, Chiera M, Galli M, Lista G. Effects of osteopathic treatment versus static touch on heart rate and oxygen saturation in premature babies: A randomized controlled trial. Complement Ther Clin Pract 2020; 39:101116. [PMID: 32379655 DOI: 10.1016/j.ctcp.2020.101116] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Osteopathic manipulative treatment (OMT) has been successfully tested in the context of preterm infants. No studies, however, have been conducted to investigate the OMT immediate effects on physiological measurements, such as partial oxygen saturation (SpO2) and heart rate (HR). The purpose of the present study was to assess the effect of osteopathic treatment on SpO2 and HR values and to compare it with 10 min of static touch. MATERIALS AND METHODS Ninety-six preterm infants (41 male), aged 33.5 weeks (±4.3) with mean weight at birth of 2067gr (±929) were recruited from the neonatal intensive care unit (NICU) of the Buzzi Hospital in Milan, and randomly allocated to two groups: OMT and Static Touch. Each protocol session consisted of: a) 5-min Pre-touch baseline recording, b) 10-min touch procedure, c) 5-min post-touch recording. Primary and secondary outcomes were, respectively, the baseline changes of HR and SpO2. RESULTS The 2 × 2 repeated measure ANOVA for HR showed a statistically significant effect (F (1,94) = 5.34; p < 0.02), revealing that the OMT group decreases the HR value at T2 (p = 0.006). In contrast, SpO2 analysis showed an increase of SpO2 value where the OMT group demonstrated higher values at T2 (p = 0.04). CONCLUSION Results from the present study suggest that a single osteopathic intervention may induce beneficial effects on preterm physiological parameters. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03833635 - Date: February 7, 2019.
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Affiliation(s)
- Andrea Manzotti
- RAISE Lab, Foundation COME Collaboration, Pescara, Italy; Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy; Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | | | - Erica Lombardi
- RAISE Lab, Foundation COME Collaboration, Pescara, Italy; Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Simona La Rocca
- RAISE Lab, Foundation COME Collaboration, Pescara, Italy; Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Marco Chiera
- RAISE Lab, Foundation COME Collaboration, Pescara, Italy
| | - Matteo Galli
- RAISE Lab, Foundation COME Collaboration, Pescara, Italy; Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Gianluca Lista
- Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy
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47
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Fister P, Nolimal M, Lenasi H, Klemenc M. The effect of sleeping position on heart rate variability in newborns. BMC Pediatr 2020; 20:156. [PMID: 32284055 PMCID: PMC7153236 DOI: 10.1186/s12887-020-02056-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 03/30/2020] [Indexed: 02/08/2023] Open
Abstract
Background Lower heart rate variability (HRV) in a newborn might represent a risk factor for unfavourable outcome, a longer recovery after illness, and a sudden infant death. Our aim was to determine whether the newborn’s sleeping position is associated with HRV. Methods We performed a prospective clinical study in 46 hospitalized cardiorespiratory stable term newborns. During sleeping, we measured the parameters of HRV in four body positions (supine, supine with tilt, prone, prone with tilt). Results The TP (total power spectral density) was significantly higher when lying supine in comparison to prone (p = 0,048) and to prone with tilt (p = 0,046). The HF (high frequency of power spectral density) in the supine position without tilt tended to be higher compared to prone without tilt (p > 0,05). The LF (low frequency power) was significantly higher when lying supine compared to prone, both without tilt (p = 0,018). TP and HF showed a positive correlation with gestational but not postmenstrual age (p = 0.044 and p = 0.036, respectively). Conclusions In term newborns, sleeping position is associated with HRV. Higher TP and HF were found in the supine position, which might reflect better ANS stability. Gestational age positively correlated with TP and HF power, but only in supine position. Trial registration ISRCTN11702082, date of registration: March, 13th, 2020; retrospectively registered.
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Affiliation(s)
- Petja Fister
- Division of Paediatrics, Department of Neonatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Manca Nolimal
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Helena Lenasi
- Institute of Physiology, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Matjaž Klemenc
- Department of Cardiology, General Hospital Nova Gorica, Nova Gorica, Slovenia.
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48
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Speer KE, Semple S, Naumovski N, McKune AJ. Heart rate variability for determining autonomic nervous system effects of lifestyle behaviors in early life: A systematic review. Physiol Behav 2020; 217:112806. [PMID: 31954147 DOI: 10.1016/j.physbeh.2020.112806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND An unhealthy lifestyle negatively alters autonomic nervous system (ANS) activity as reflected by decreased heart rate variability (HRV), increasing cardiovascular disease (CVD) risk. Research investigating the effect of modifiable lifestyle factors on ANS activity in young children is limited. Early identification of these risk factors is vital to improving long-term individual and public health outcomes. A systematic review was conducted to assess the effect of maternal or child modifiable lifestyle factors on child ANS activity. METHODS Following the 2009 PRISMA guidelines, three electronic databases were searched from February 2018 - July 2019 for articles describing human trials between 1996 - 2019. Included studies examined ANS activity of children between 28 weeks gestational age - 6 years in relation to modifiable lifestyle CVD risk factors. RESULTS Twenty-six studies fulfilled inclusion criteria. Sixteen studies reported that modifiable lifestyle factors significantly influenced the HRV of children. Increased HRV was significantly associated with higher maternal zinc and omega-3 fatty acid intake, regular maternal aerobic exercise and a non-smoking environment. Child diet and body composition demonstrated some support for an association between these modifiable lifestyle factors and child HRV. CONCLUSION There is cross-sectional evidence supporting an association between maternal lifestyle factors and child HRV. Evidence is less supportive of a relationship between child modifiable lifestyle factors and child HRV. Monitoring the effects of lifestyle interventions on the ANS via HRV measurements of both mother and child may identify child CVD risk.
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Affiliation(s)
- Kathryn E Speer
- Faculty of Health, Discipline of Sport and Exercise Science/University of Canberra, Canberra, (ACT,) Australia; Research Institute for Sport and Exercise/University of Canberra, Canberra, (ACT,) Australia.
| | - Stuart Semple
- Faculty of Health, Discipline of Sport and Exercise Science/University of Canberra, Canberra, (ACT,) Australia; Research Institute for Sport and Exercise/University of Canberra, Canberra, (ACT,) Australia
| | - Nenad Naumovski
- Faculty of Health, University of Canberra, Canberra, (ACT,) Australia
| | - Andrew J McKune
- Faculty of Health, Discipline of Sport and Exercise Science/University of Canberra, Canberra, (ACT,) Australia; Research Institute for Sport and Exercise/University of Canberra, Canberra, (ACT,) Australia; Discipline of Biokinetics, Exercise and Leisure Sciences, School of Health Sciences/ University of KwaZulu-Natal, Durban, (KwaZulu-Natal,) South Africa
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49
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Mannella P, Billeci L, Giannini A, Canu A, Pancetti F, Simoncini T, Varanini M. A feasibility study on non-invasive fetal ECG to evaluate prenatal autonomic nervous system activity. Eur J Obstet Gynecol Reprod Biol 2020; 246:60-66. [PMID: 31962257 DOI: 10.1016/j.ejogrb.2020.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/07/2020] [Accepted: 01/11/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Maturity of the autonomic nervous system (ANS) is of paramount importance for fetal adaptation to extrauterine life and for early neurological development. Markers of ANS maturity, such as electrophysiological heart rate parameters, are of interest as tools to determine prenatal fetal maturity. The available technology, fetal magnetocardiography is expensive and not suitable for clinical use. Detection of fetal electrocardiographic signals using traditional ECG leads on the maternal abdomen may be brought to the bedside, but is technically challenging. Our group has recently developed an innovative system consisting of a standard ECG with external leads applied on the maternal abdomen coupled with a software that extracts the fetal heart signal from the maternal noise. OBJECTIVE To validate the use of this innovative non-invasive system to detect fetal ECG (fECG) and its ability to detect changes in electrophysiological fetal cardiac parameters associated with ANS maturation. STUDY DESIGN we recruited 50 pregnant women between 24 and 41 weeks and they received non-invasive recording of fECG. RESULTS fECG was measurable at all gestational ages. Fetal heart rate variability (RR interval) and other associated parameters, such as low and high frequency increased with gestational age, particularly up to the 31st week. CONCLUSIONS This study shows that non-invasive fECG is feasible throughout a broad range of gestational ages and allows detecting electrophysiological parameters of the fetal heart that may be used a surrogate of ANS maturity. Technological implementation of this system and its further exploitation may generate new tool to estimate fetal maturity.
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Affiliation(s)
- Paolo Mannella
- Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - Lucia Billeci
- Institute of Clinical Physiology (IFC) National Research Council (CNR), Pisa, Italy
| | - Andrea Giannini
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Alessio Canu
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Federica Pancetti
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Maurizio Varanini
- Institute of Clinical Physiology (IFC) National Research Council (CNR), Pisa, Italy
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Cardiac Autonomic Function in the First Hours of Postnatal Life: An Observational Cross-Sectional Study in Term Neonates. Pediatr Cardiol 2019; 40:1703-1708. [PMID: 31529226 DOI: 10.1007/s00246-019-02207-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 09/04/2019] [Indexed: 10/26/2022]
Abstract
The aim of this study was to evaluate heart rate variability (HRV) within the first hours of extrauterine life in term neonates. HRV at 2-h and 14-h postpartum were compared by means of time domains (iRR, SDNN, and rMSSD); frequency domains (TP, LF, HF, and LF/HF ratio); and Poincare's Plot (SD1 and SD2) indices of HRV in 27 healthy, male, term newborns (NBs) born of elective cesarean delivery. Within 14 h after birth, the mean of the iRRs increased (Δ% = 4.4, p < 0.001) as well as parasympathetic indices (rMSSD: Δ% = 32.6; p < 0.03; HF: Δ% = 43.6; p < 0.00; SD1: Δ% = 32.6, p < 0.03). Respiratory rate (RR) decreased (RR: 2 h = 48 (43-55) cycle/min vs. 14 h = 45 (40-48) cycle/min p < 0.01). We concluded that within the first 14 h of birth, cardiac autonomic adjustments are characterized by an increase in parasympathetic activity. Concurrently, there were no significant changes observed in all other HRV indices in healthy, male, term neonates, and born of elective cesarean delivery.
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