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Rahman J, Brankovic A, Khanna S. Machine learning model with output correction: Towards reliable bradycardia detection in neonates. Comput Biol Med 2024; 177:108658. [PMID: 38833801 DOI: 10.1016/j.compbiomed.2024.108658] [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: 10/22/2023] [Revised: 04/30/2024] [Accepted: 05/23/2024] [Indexed: 06/06/2024]
Abstract
Bradycardia is a commonly occurring condition in premature infants, often causing serious consequences and cardiovascular complications. Reliable and accurate detection of bradycardia events is pivotal for timely intervention and effective treatment. Excessive false alarms pose a critical problem in bradycardia event detection, eroding trust in machine learning (ML)-based clinical decision support tools designed for such detection. This could result in disregarding the algorithm's accurate recommendations and disrupting workflows, potentially compromising the quality of patient care. This article introduces an ML-based approach incorporating an output correction element, designed to minimise false alarms. The approach has been applied to bradycardia detection in preterm infants. We applied five ML-based autoencoder techniques, using recurrent neural network (RNN), long-short-term memory (LSTM), gated recurrent unit (GRU), 1D convolutional neural network (1D CNN), and a combination of 1D CNN and LSTM. The analysis is performed on ∼440 hours of real-time preterm infant data. The proposed approach achieved 0.978, 0.73, 0.992, 0.671 and 0.007 in AUC-ROC, AUC-PRC, recall, F1 score, and false positive rate (FPR) respectively and a false alarms reduction of 36% when compared with methods without the correction approach. This study underscores the imperative of cultivating solutions that alleviate alarm fatigue and encourage active engagement among healthcare professionals.
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Presacco A, Chirumamilla VC, Vezina G, Li R, Du Plessis A, Massaro AN, Govindan RB. Prediction of outcome of hypoxic-ischemic encephalopathy in newborns undergoing therapeutic hypothermia using heart rate variability. J Perinatol 2024; 44:521-527. [PMID: 37604967 DOI: 10.1038/s41372-023-01754-w] [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] [Received: 03/21/2023] [Revised: 07/31/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE To assess the use of continuous heart rate variability (HRV) as a predictor of brain injury severity in newborns with moderate to severe HIE that undergo therapeutic hypothermia. STUDY DESIGN Two cohorts of newborns (n1 = 55, n2 = 41) with moderate to severe hypoxic-ischemic encephalopathy previously treated with therapeutic hypothermia. HRV was characterized by root mean square in the short time scales (RMSS) during therapeutic hypothermia and through completion of rewarming. A logistic regression and Naïve Bayes models were developed to predict the MRI outcome of the infants using RMSS. The encephalopathy grade and gender were used as control variables. RESULTS For both cohorts, the predicted outcomes were compared with the observed outcomes. Our algorithms were able to predict the outcomes with an area under the receiver operating characteristic curve of about 0.8. CONCLUSIONS HRV assessed by RMSS can predict severity of brain injury in newborns with HIE.
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Affiliation(s)
- Alessandro Presacco
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA.
| | | | - Gilbert Vezina
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
- Division of Neonatology, Children's National Hospital, Washington, DC, USA
| | - Ruoying Li
- Division of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, DC, USA
| | - Adre Du Plessis
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, The George Washington University School of Medicine, Washington, DC, USA
| | - An N Massaro
- Division of Neonatology, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, The George Washington University School of Medicine, Washington, DC, USA
| | - Rathinaswamy B Govindan
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, The George Washington University School of Medicine, Washington, DC, USA
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Dantas FMNA, Magalhães PAF, Hora ECN, Andrade LB, Sarinho ESC. Heart rate variability in school-age children born moderate-to-late preterm. Early Hum Dev 2024; 189:105922. [PMID: 38163385 DOI: 10.1016/j.earlhumdev.2023.105922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 11/27/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Prematurity is associated with reduced cardiac autonomic function. This study aimed to investigate the heart rate variability (HRV) in school-age children born moderately to late preterm (MLPT). METHODS This cross-sectional study investigated school-age children, aged 5 to 10 years, born moderate-to-late preterm. Electrocardiograms recordings were performed during fifteen-minutes. Time and frequency domain parameters were calculated, corrected for heart rate and compared between the groups. RESULTS A total of 123 children were evaluated and 119 were included in this study. HRV measures, studied in the time and frequency domains, were similar in both groups. Corrected values of root mean square of successive differences between normal cycles (RMSSD), percentage of successive cycles with a duration difference >50 ms (pNN50%), and high frequency (HF), indices that predominantly represent the parasympathetic activity of the autonomic nervous system, were 1.6E-7 and 1.8E-7 (p=0.226); 1.6E-13 and 1.6E-13 (p=0.506); 6.9E-12 and 7.4E-12 (p=0.968) in the preterm and control groups, respectively. CONCLUSION This study did not find differences in heart rate variability between school-age children born MLPT and those born at term, suggesting that plasticity of cardiac autonomic modulation continues to occur in children up to school age or there is less impairment of the autonomic system in MLPT.
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Affiliation(s)
- Fabianne M N A Dantas
- Research Group of Neonatal and Pediatric Physical Therapy, Baby GrUPE, Universidade de Pernambuco, Petrolina, Pernambuco, Brazil; Department of Physical Therapy, Universidade de Pernambuco, Pernambuco, Brazil.
| | - Paulo A F Magalhães
- Research Group of Neonatal and Pediatric Physical Therapy, Baby GrUPE, Universidade de Pernambuco, Petrolina, Pernambuco, Brazil; Department of Physical Therapy, Universidade de Pernambuco, Pernambuco, Brazil; Graduate Program in Rehabilitation and Functional Performance, Universidade de Pernambuco, Petrolina, Pernambuco, Brazil
| | - Emilly C N Hora
- Universidade Federal de Sergipe, Aracaju, Pernambuco, Brazil
| | - Lívia B Andrade
- Professor Fernando Figueira Integral Medicine Institute, Recife, Pernambuco, Brazil
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Hou J, Lu K, Chen P, Wang P, Li J, Yang J, Liu Q, Xue Q, Tang Z, Pei H. Comprehensive viewpoints on heart rate variability at high altitude. Clin Exp Hypertens 2023; 45:2238923. [PMID: 37552638 DOI: 10.1080/10641963.2023.2238923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVES Hypoxia is a physiological state characterized by reduced oxygen levels in organs and tissues. It is a common clinicopathological process and a major cause of health problems in highland areas. Heart rate variability (HRV) is a measure of the balance in autonomic innervation to the heart. It provides valuable information on the regulation of the cardiovascular system by neurohumoral factors, and changes in HRV reflect the complex interactions between multiple systems. In this review, we provide a comprehensive overview of the relationship between high-altitude hypoxia and HRV. We summarize the different mechanisms of diseases caused by hypoxia and explore the changes in HRV across various systems. Additionally, we discuss relevant pharmaceutical interventions. Overall, this review aims to provide research ideas and assistance for in-depth studies on HRV. By understanding the intricate relationship between high-altitude hypoxia and HRV, we can gain insights into the underlying mechanisms and potential therapeutic approaches to mitigate the effects of hypoxia on cardiovascular and other systems. METHODS The relevant literature was collected systematically from scientific database, including PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Baidu Scholar, as well as other literature sources, such as classic books of hypoxia. RESULTS There is a close relationship between heart rate variability and high-altitude hypoxia. Heart rate variability is an indicator that evaluates the impact of hypoxia on the cardiovascular system and other related systems. By improving the observation of HRV, we can estimate the progress of cardiovascular diseases and predict the impact on other systems related to cardiovascular health. At the same time, changes in heart rate variability can be used to observe the efficacy of preventive drugs for altitude related diseases. CONCLUSIONS HRV can be used to assess autonomic nervous function under various systemic conditions, and can be used to predict and monitor diseases caused by hypoxia at high altitude. Investigating the correlation between high altitude hypoxia and heart rate variability can help make HRV more rapid, accurate, and effective for the diagnosis of plateau-related diseases.
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Affiliation(s)
- Jun Hou
- Department of Cardiology, Chengdu Third People's Hospital, Affiliated Hospital of Southwest Jiao Tong University, Cardiovascular Disease Research Institute of Chengdu, Chengdu, China
| | - Keji Lu
- School of Medical and Life Sciences, Chengdu University of TCM, Chengdu, China
| | - Peiwen Chen
- School of Medical and Life Sciences, Chengdu University of TCM, Chengdu, China
| | - Peng Wang
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Jing Li
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Jiali Yang
- Department of Cardiology, Chengdu Third People's Hospital, Affiliated Hospital of Southwest Jiao Tong University, Cardiovascular Disease Research Institute of Chengdu, Chengdu, China
| | - Qing Liu
- Department of Medical Engineering, The 950th Hospital of PLA, Yecheng, Xinjiang, China
| | - Qiang Xue
- Department of Cardiology Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Zhaobing Tang
- Department of Rehabilitation Medicine, The General Hospital of Western Theater Command, Chengdu, China
| | - Haifeng Pei
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
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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 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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Shalish W, Sant'Anna GM. Towards precision medicine for extubation of extremely preterm infants: is variability the spice of life? Pediatr Res 2023; 93:748-750. [PMID: 36564479 DOI: 10.1038/s41390-022-02447-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Wissam Shalish
- Department of Pediatrics, Neonatology, McGill University Health Center, Montreal, Quebec, Canada.
| | - Guilherme M Sant'Anna
- Department of Pediatrics, Neonatology, McGill University Health Center, Montreal, Quebec, Canada
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Kokkinaki T, Markodimitraki M, Giannakakis G, Anastasiou I, Hatzidaki E. Comparing Full and Pre-Term Neonates' Heart Rate Variability in Rest Condition and during Spontaneous Interactions with Their Parents at Home. Healthcare (Basel) 2023; 11:healthcare11050672. [PMID: 36900677 PMCID: PMC10000654 DOI: 10.3390/healthcare11050672] [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: 01/21/2023] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Preterm neonates show decreased HRV compared to those at full-term. We compared HRV metrics between preterm and full-term neonates in transfer periods from neonate rest state to neonate-parent interaction, and vice versa. METHODS Short-term recordings of the HRV parameters (time and frequency-domain indices and non-linear measurements) of 28 premature healthy neonates were compared with the metrics of 18 full-term neonates. HRV recordings were performed at home at term-equivalent age and HRV metrics were compared between the following transfer periods: from first rest state of the neonate (TI1) to a period in which the neonate interacted with the first parent (TI2), from TI2 to a second neonate rest state (TI3), and from TI3 to a period of neonate interaction with the second parent (TI4). RESULTS For the whole HRV recording period, PNN50, NN50 and HF (%) was lower for preterm neonates compared to full-terms. These findings support the reduced parasympathetic activity of preterm compared to full-term neonates. The results of comparisons between transfer period simply a common coactivation of SNS and PNS systems for both full and pre-term neonates. CONCLUSIONS Spontaneous interaction with the parent may reinforce both full and pre-term neonates' ANS maturation.
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Affiliation(s)
- Theano Kokkinaki
- Child Development and Education Unit, Laboratory of Applied Psychology, Department of Psychology, University of Crete, 74150 Rethymnon, Greece
- Correspondence: ; Tel.: +30-28310-77536
| | | | - Giorgos Giannakakis
- Institute of Computer Science, Foundation for Research and Technology, 70013 Heraklion, Greece
| | - Ioannis Anastasiou
- Cardiology Department, University Hospital of Heraklion, University of Crete, 71500 Heraklion, Greece
| | - Eleftheria Hatzidaki
- Department of Neonatology/Neonatal Intensive Care Unit, University Hospital of Heraklion, School of Medicine, University of Crete, 71500 Heraklion, Greece
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Donkey Heart Rate and Heart Rate Variability: A Scoping Review. Animals (Basel) 2023; 13:ani13030408. [PMID: 36766295 PMCID: PMC9913831 DOI: 10.3390/ani13030408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
Heart rate (HR) and heart rate variability (HRV) are commonly used physiological measures in animals. While several studies exist on horse HRV, less information is available for donkeys. This scoping review aims to understand the extent and type of published evidence on donkey HR and HRV, their clinical and research applications, the devices used, and the analysis performed. Only quantitative primary studies published in English were considered. Four different databases were queried through the Web of Science platform, with additional evidence identified by citation chasing. After a two-stage screening phase, data were extracted considering study and population characteristics, information on HR/HRV analysis, and applications. The majority of the 87 included articles (about 80%) concerned a sample size of up to 20 individuals and were published since 2011 (about 65%). Forty-one articles employed an electronic device for signal acquisition (mainly electrocardiographs and heart rate monitors), yet only two articles reported HRV parameters. The literature on donkey HRV is lacking, and this gap can be filled by gaining knowledge on donkey characteristics and finding useful tools for welfare assessment. Comparison with what is known about the horse allows a discussion of the technical and interpretative difficulties that can be encountered with donkeys.
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Pavel A, Mathieson SR, Livingstone V, O’Toole JM, Pressler RM, de Vries LS, Rennie JM, Mitra S, Dempsey EM, Murray DM, Marnane WP, Boylan GB. Heart rate variability analysis for the prediction of EEG grade in infants with hypoxic ischaemic encephalopathy within the first 12 h of birth. Front Pediatr 2023; 10:1016211. [PMID: 36683815 PMCID: PMC9845713 DOI: 10.3389/fped.2022.1016211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/16/2022] [Indexed: 01/06/2023] Open
Abstract
Background and aims Heart rate variability (HRV) has previously been assessed as a biomarker for brain injury and prognosis in neonates. The aim of this cohort study was to use HRV to predict the electroencephalography (EEG) grade in neonatal hypoxic-ischaemic encephalopathy (HIE) within the first 12 h. Methods We included 120 infants with HIE recruited as part of two European multi-centre studies, with electrocardiography (ECG) and EEG monitoring performed before 12 h of age. HRV features and EEG background were assessed using the earliest 1 h epoch of ECG-EEG monitoring. HRV was expressed in time, frequency and complexity features. EEG background was graded from 0-normal, 1-mild, 2-moderate, 3-major abnormalities to 4-inactive. Clinical parameters known within 6 h of birth were collected (intrapartum complications, foetal distress, gestational age, mode of delivery, gender, birth weight, Apgar at 1 and 5, assisted ventilation at 10 min). Using logistic regression analysis, prediction models for EEG severity were developed for HRV features and clinical parameters, separately and combined. Multivariable model analysis included 101 infants without missing data. Results Of 120 infants included, 54 (45%) had normal-mild and 66 (55%) had moderate-severe EEG grade. The performance of HRV model was AUROC 0.837 (95% CI: 0.759-0.914) and clinical model was AUROC 0.836 (95% CI: 0.759-0.914). The HRV and clinical model combined had an AUROC of 0.895 (95% CI: 0.832-0.958). Therapeutic hypothermia and anti-seizure medication did not affect the model performance. Conclusions Early HRV and clinical information accurately predicted EEG grade in HIE within the first 12 h of birth. This might be beneficial when EEG monitoring is not available in the early postnatal period and for referral centres who may want some objective information on HIE severity.
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Affiliation(s)
- Andreea M Pavel
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Sean R Mathieson
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Vicki Livingstone
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - John M O’Toole
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Ronit M Pressler
- Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Linda S de Vries
- Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Janet M Rennie
- Institute for Women's Health, University College London, London, United Kingdom
| | - Subhabrata Mitra
- Institute for Women's Health, University College London, London, United Kingdom
| | - Eugene M Dempsey
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Deirdre M Murray
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - William P Marnane
- INFANT Research Centre, University College Cork, Cork, Ireland
- School of Engineering, University College Cork, Cork, Ireland
| | - Geraldine B Boylan
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
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