Pre-discharge Cardiorespiratory Monitoring in Preterm Infants. the CORE Study

Effects of a valved infant-bottle with ergonomic teat on the coordination of sucking, swallowing, and respiration in late-preterm infants. The Safe Oral Feeding randomized Trial

Introduction

Breastfeeding naturally enables the coordination of sucking, swallowing, and respiration patterns for safe feeding. When breastfeeding is not possible a feeding device that releases milk in response to intra-oral vacuum could potentially offer improved coordination of sucking, swallowing, and breathing patterns compared to conventional devices. The aim of the study is to evaluate the effect of a valved infant-bottle with an ergonomic teat compared to a standard infant-bottle.

Methods

This unblinded randomized controlled trial focused on late preterm infants fed by bottle for at least three meals over the day, admitted to the Neonatal Unit of Sant'Anna Hospital (Turin, Italy). Infants were randomized to be fed with a valved infant-bottle with an ergonomic teat (B-EXP arm) or with a standard infant-bottle (B-STD arm). Monitoring included a simultaneous synchronized recording of sucking, swallowing and respiration. The main outcome was the swallowing/breathing ratio.

Results

Forty infants (20 B-EXP arm; 20 B-STD arm) with a median gestational age of 35.0 weeks (IQR 35.0-36.0 weeks) completed the study. Four infants were censored for the presence of artifacts in the polygraphic traces. The median swallowing/breathing ratio was 1.11 (1.03-1.23) in the B-EXP arm and 1.75 (1.21-2.06) in the B-STD (p = .003). A lower frequency of swallowing events during the inspiratory phase of breathing was observed in B-EXP arm compared with B-STD arm (p = 0.013).

Discussion

The valved infant-bottle with an ergonomic teat improves the coordination of sucking-swallowing-respiration and limits the risk of inhalation reducing the frequency of swallowing during the inspiratory phase.

Air Pollution and Aeroallergens as Possible Triggers in Preterm Birth Delivery

Preterm birth (PTB) identifies infants prematurely born <37 weeks/gestation and is one of the main causes of infant mortality. PTB has been linked to air pollution exposure, but its timing is still unclear and neglects the acute nature of delivery and its association with short-term effects. We analyzed 3 years of birth data (2015−2017) in Turin (Italy) and the relationships with proinflammatory chemicals (PM2.5, O3, and NO2) and biological (aeroallergens) pollutants on PTB vs. at-term birth, in the narrow window of a week before delivery. A tailored non-stationary Poisson model correcting for seasonality and possible confounding variables was applied. Relative risk associated with each pollutant was assessed at any time lag between 0 and 7 days prior to delivery. PTB risk was significantly associated with increased levels of both chemical (PM2.5, RR = 1.023 (1.003−1.043), O3, 1.025 (1.001−1.048)) and biological (aeroallergens, RR ~ 1.01 (1.0002−1.016)) pollutants in the week prior to delivery. None of these, except for NO2 (RR = 1.01 (1.002−1.021)), appeared to play any role on at-term delivery. Pollutant-induced acute inflammation eliciting delivery in at-risk pregnancies may represent the pathophysiological link between air pollution and PTB, as testified by the different effects played on PTB revealed. Further studies are needed to better elucidate a possible exposure threshold to prevent PTB.

Incidence and Parental Perception of Cardiorespiratory Monitor Use in Preterm Infants

The objective of this study is to examine the incidence and clinical indicators for use of cardiorespiratory (CR) monitor use. We also examined parents' perceptions on the usefulness of home CR monitoring when their preterm infants were discharged from the hospital. A retrospective patients record review was conducted to assess CR monitor use at discharge in preterm infants from January 1, 2016, to December 31, 2017. Participants received a telephone survey that examined parents' CR monitor experiences and use. Over the study period, forty-four infants were discharged home on CR monitor with the incidence rate of 8.1%. Of those, 28 parents were surveyed between 1 and 2 years post discharge. Most parents reported feeling secure but anxious using the CR monitor. Parents who reported experiencing false alarms frequently also reported having feelings of anxiety while using the CR monitor. Findings from this preliminary study support the importance of understanding the role of parent perceptions of families with infants on CR monitors.

Automated Medical Care: Bradycardia Detection and Cardiac Monitoring of Preterm Infants

Background and Objectives: Prematurity of birth occurs before the 37th week of gestation and affects up to 10% of births worldwide. It is correlated with critical outcomes; therefore, constant monitoring in neonatal intensive care units or home environments is required. The aim of this work was to develop solutions for remote neonatal intensive supervision systems, which should assist medical diagnosis of premature infants and raise alarm at cardiac abnormalities, such as bradycardia. Additionally, the COVID-19 pandemic has put a worldwide stress upon the medical staff and the management of healthcare units. Materials and Methods: A traditional medical diagnosing scheme was set up, implemented with the aid of powerful mathematical operators. The algorithm was tailored to the infants' personal ECG characteristics and was tested on real ECG data from the publicly available PhysioNet database "Preterm Infant Cardio-Respiratory Signals Database". Different processing problems were solved: noise filtering, baseline drift removal, event detection and compression of medical data using the à trous wavelet transform. Results: In all 10 available clinical cases, the bradycardia events annotated by the physicians were correctly detected using the RR intervals. Compressing the ECG signals for remote transmission, we obtained compression ratios (CR) varying from 1.72 to 7.42, with the median CR value around 3. Conclusions: We noticed that a significant amount of noise can be added to a signal while monitoring using standard clinical sensors. We tried to offer solutions for these technical problems. Recent studies have shown that persons infected with the COVID-19 disease are frequently reported to develop cardiovascular symptoms and cardiac arrhythmias. An automatic surveillance system (both for neonates and adults) has a practical medical application. The proposed algorithm is personalized, no fixed reference value being applied, and the algorithm follows the neonate's cardiac rhythm changes. The performance depends on the characteristics of the input ECG. The signal-to-noise ratio of the processed ECG was improved, with a value of up to 10 dB.

Are we over-treating hypoxic spells in preterm infants?

A frequent challenge in Neonatology is the high frequency of spontaneously occurring hypoxemic events, a majority of which are associated with apnea or hypoventilation. These episodes present a challenge for caregivers and families as they frequently delay discharge of preterm infants. Supplemental oxygen, respiratory support, and caffeine therapy are widely used as therapeutic approaches, but challenges remain regarding their precise indications. Future clinical practice should be directed by an evidence-based approach including automated supplemental oxygen, minimizing the use of medications for gastroesophageal reflux, optimal timing and dosage of caffeine therapy, and standardization of alarm limits and discharge monitoring protocols.