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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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Influence of Spontaneous and Mechanical Ventilation on Frequency-Based Measures of Heart Rate Variability. Crit Care Res Pract 2022; 2021:8709262. [PMID: 34987867 PMCID: PMC8720601 DOI: 10.1155/2021/8709262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022] Open
Abstract
Frequency-based measures of heart rate variability have been shown to be a useful physiological marker in both clinical and research settings providing insight into the functioning of the autonomic nervous system. Ongoing interactions between the autonomic nervous system control of the heart and lung occurs during each ventilation cycle because of their anatomical position within the closed thoracic cavity. Mechanical ventilation and subsequent removal change the normal ventilator mechanics producing alterations in the tidal volume, intrathoracic pressure, and oxygen delivery. A noninvasive method called heart rate variability (HRV) can be used to evaluate this interaction during ventilation and can be quantified by applying frequency-based measures of the variability between heartbeats. Although HRV is a reliable method to measure alteration of the autonomic nervous system (ANS) function and cardiopulmonary interaction, there have been limited reports concerning the changes in the frequency-based measure of HRV during both spontaneous and mechanical ventilation. The purpose of this methodological study is therefore to describe the physiological influence of both spontaneous and mechanical ventilation on frequency-based measures of HRV.
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3
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The value of cardiorespiratory parameters for sleep state classification in preterm infants: A systematic review. Sleep Med Rev 2021; 58:101462. [PMID: 33826975 DOI: 10.1016/j.smrv.2021.101462] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 02/24/2021] [Accepted: 03/03/2021] [Indexed: 11/23/2022]
Abstract
Cardiorespiratory activity is highly associated with infants' sleep duration and quality. We performed a systematic literature search of PubMed and EMBASE databases to investigate if and how cardiorespiratory parameters can be used for sleep state classification in preterm infants and in what way maturation influences this relation. All retrieved citations were screened against predetermined inclusion and exclusion criteria. Only studies of preterm infants (<37 wk postmenstrual age during sleep state classification) admitted to a neonatal ward and of whom at least one sleep state and one cardiorespiratory parameter was measured, were included. Two researchers independently reviewed the included studies on methodological quality. Of the 1097 initially retrieved studies, 23 were included for analysis. Heart rate and respiration frequency are strongly correlated with active sleep and quiet sleep. In quiet sleep, as compared to active sleep, respiratory frequency is more stable, and the heart rate is lower and less variable. This association, however, differed across preterm birth subtypes (i.e., extremely, very or late preterm), indicating that maturation - in the form of both gestational and postnatal age - influences the cardiorespiratory characteristics of preterm sleep states. The knowledge gained from this review can help improve behavioral sleep classification and automated sleep classification algorithms for preterm infants.
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Kozar M, Tonhajzerova I, Mestanik M, Matasova K, Zibolen M, Calkovska A, Javorka K. Heart rate variability in healthy term newborns is related to delivery mode: a prospective observational study. BMC Pregnancy Childbirth 2018; 18:264. [PMID: 29945544 PMCID: PMC6020381 DOI: 10.1186/s12884-018-1900-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/17/2018] [Indexed: 11/17/2022] Open
Abstract
Background Early postnatal period is characterized by dramatic adaptation changes of cardiovascular and respiratory systems in newborns. There is still insufficient data regarding maturation of autonomic regulatory mechanisms in neonates early after delivery. Aim of this study was to analyze cardiac autonomic regulation in newborns within the first few postnatal days in relation to different modes of delivery using time and spectral heart rate variability analysis. Methods Eutrophic healthy term newborns (n = 46) were divided into three groups according to the delivery mode: vaginal delivery (VD group; n = 16), vaginal delivery with epidural analgesia (EDA group; n = 16), and caesarean section under general anesthesia (CS group; n = 14). Heart rate variability (HRV), blood pressure (BP), and blood oxygen saturation (SpO2) were measured within the first two hours after birth and on the third to fourth postnatal day. HRV parameters were evaluated in the time domain (RR intervals, mean square of successive differences – MSSD) and frequency domain (total spectral power – TP, absolute and relative low and high frequency powers). Results The HRV spectral analysis showed significantly higher relative power of the high-frequency band (HF%) in the VD group compared to the CS group early after delivery (p = 0.002). HRV parameters and BP significantly increased on the third to fourth postnatal day in all groups (p < 0.05). No significant differences in basic characteristics, BP and SpO2 were identified between groups during both measurements. Conclusions HRV analysis revealed higher cardiovagal modulation in spontaneously born newborns without analgesia compared to neonates born by caesarean section. It could represent a potential pathomechanism that leads to discrete abnormal neurocardiac regulation associated with higher risk for worsened postnatal adaptation of cardiovascular system in surgically delivered neonates.
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Affiliation(s)
- Marek Kozar
- Department of Neonatology, University Hospital in Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Kollarova 2, 03659, Martin, Slovakia
| | - Ingrid Tonhajzerova
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Mala Hora 4C, 03601, Martin, Slovakia.,Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Mala Hora 4C, 03601, Martin, Slovakia
| | - Michal Mestanik
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Mala Hora 4C, 03601, Martin, Slovakia.,Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Mala Hora 4C, 03601, Martin, Slovakia
| | - Katarina Matasova
- Department of Neonatology, University Hospital in Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Kollarova 2, 03659, Martin, Slovakia
| | - Mirko Zibolen
- Department of Neonatology, University Hospital in Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Kollarova 2, 03659, Martin, Slovakia
| | - Andrea Calkovska
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Mala Hora 4C, 03601, Martin, Slovakia.,Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Mala Hora 4C, 03601, Martin, Slovakia
| | - Kamil Javorka
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Mala Hora 4C, 03601, Martin, Slovakia. .,Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Mala Hora 4C, 03601, Martin, Slovakia.
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Uchida MO, Arimitsu T, Yatabe K, Ikeda K, Takahashi T, Minagawa Y. Effect of mother's voice on neonatal respiratory activity and EEG delta amplitude. Dev Psychobiol 2018; 60:140-149. [PMID: 29205320 PMCID: PMC5836877 DOI: 10.1002/dev.21596] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 11/12/2017] [Indexed: 11/12/2022]
Abstract
While the influence of the mother's voice on neonatal heart-rate response and its relevant activity on cerebral cortex and the autonomic nervous system (ANS) are well known, few studies have assessed its influence on respiratory activity. We investigated the relationship among the respiration rate, the delta wave amplitudes through electroencephalography, and the basal state of ANS through the respiratory variability index while 22 full-term neonates hear their mother's voice and an unknown voice. It was found that when respiratory variability was large, a transient (<5 s) change in respiration rates was observed in response to an unknown voice, while a greater increase in the delta wave amplitude was observed in the frontal lobe than the parietal one in response to the mother's voice. Conversely, when respiratory variability was small, a sustained increase (>10 s) in respiration rates was observed in response to the mother's voice, while a greater increase in the delta wave amplitude was found in both the frontal and parietal lobes. These results suggest that the basal state of ANS influences the latency of increases in respiration rates. Furthermore, induced by the mother's voice, transient increases in respiration rates are reduced in association with frontal lobe activity, and sustained increases in respiration rates are promoted in association with frontal and parietal lobe activities.
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Affiliation(s)
- Mariko O. Uchida
- Department of PsychologyFaculty of Integrated Arts and Social SciencesJapan Women's UniversityKanagawaJapan
- Global COE ProgramCenter for Advanced Research on Logic and SensibilityKeio UniversityTokyoJapan
| | - Takeshi Arimitsu
- Department of Pediatrics Keio University School of MedicineTokyoJapan
| | - Kiyomi Yatabe
- Global Centre for Advanced Research on Logic and SensibilityKeio UniversityTokyoJapan
| | - Kazushige Ikeda
- Department of Pediatrics Keio University School of MedicineTokyoJapan
| | - Takao Takahashi
- Department of Pediatrics Keio University School of MedicineTokyoJapan
| | - Yasuyo Minagawa
- Department of PsychologyFaculty of LettersKeio UniversityYokohamaJapan
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Sheen T, Lu M, Lee M, Chen S. Nonreassuring fetal heart rate decreases heart rate variability in newborn infants. Ann Noninvasive Electrocardiol 2014; 19:273-8. [PMID: 24766264 PMCID: PMC6932643 DOI: 10.1111/anec.12139] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Nonreassuring fetal status (NRFS) refers to a compromised fetal condition which implies hypoxia. The influence of intrapartum hypoxia on autonomic nervous system function in early postnatal life is unknown. This study explored the influence of NRFS on the heart rate variability (HRV) of newborn infants. METHODS Singleton newborn infants delivered through Cesarean delivery (CD) with indications of elective purpose (n = 32), dystocia (n = 29), or NRFS (n = 22), and through vaginal birth (VB) (n = 80) were consecutively collected. HRV parameters including standard deviation of average NN intervals (SDANN), low frequency (LF), high frequency (HF), LF%, HF%, and total power (TP), were obtained for analysis in 3 days postpartum. An independent t-test or one-way ANOVA was used to compare differences in numeric data. RESULTS SDANN, HF, HF%, and TP of newborn infants in the VB group were significantly higher than those in the CD group. The NRFS group had significantly lower SDANN, HF, and TP than those of the elective group, and significantly lower HF, HF%, and TP than those of the dystocia group. CONCLUSIONS Newborn infants delivered through Cesarean section had lower HRV, especially those who experienced NRFS during labor. The long-term effects of changes of HRV in neonates require further evaluation.
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Affiliation(s)
- Tzong‐Chyi Sheen
- Department of Obstetrics and GynecologyYuan's General HospitalNo. 162, Chenggong 1st Rd.Kaohsiung 802Taiwan
| | - Ming‐Huei Lu
- Department of Nursing, Mackay Memorial HospitalNo. 92, Sec. 2, Chungshan N. Rd.Taipei 104Taiwan
| | - Mei‐Yu Lee
- Department of Nursing, Mackay Memorial HospitalNo. 92, Sec. 2, Chungshan N. Rd.Taipei 104Taiwan
| | - Su‐Ru Chen
- School of NursingCollege of NursingTaipei Medical UniversityNo. 250, Wuxing St.Taipei 110Taiwan
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7
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Huang CT, Tsai YJ, Lin JW, Ruan SY, Wu HD, Yu CJ. Application of heart-rate variability in patients undergoing weaning from mechanical ventilation. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:R21. [PMID: 24456585 PMCID: PMC4056081 DOI: 10.1186/cc13705] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 01/20/2014] [Indexed: 01/08/2023]
Abstract
Introduction The process of weaning may impose cardiopulmonary stress on ventilated patients. Heart-rate variability (HRV), a noninvasive tool to characterize autonomic function and cardiorespiratory interaction, may be a promising modality to assess patient capability during the weaning process. We aimed to evaluate the association between HRV change and weaning outcomes in critically ill patients. Methods This study included 101 consecutive patients recovering from acute respiratory failure. Frequency-domain analysis, including very low frequency, low frequency, high frequency, and total power of HRV was assessed during a 1-hour spontaneous breathing trial (SBT) through a T-piece and after extubation after successful SBT. Results Of 101 patients, 24 (24%) had SBT failure, and HRV analysis in these patients showed a significant decrease in total power (P = 0.003); 77 patients passed SBT and were extubated, but 13 (17%) of them required reintubation within 72 hours. In successfully extubated patients, very low frequency and total power from SBT to postextubation significantly increased (P = 0.003 and P = 0.004, respectively). Instead, patients with extubation failure were unable to increase HRV after extubation. Conclusions HRV responses differ between patients with different weaning outcomes. Measuring HRV change during the weaning process may help clinicians to predict weaning results and, in the end, to improve patient care and outcome.
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8
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Hambleton MT, Reynolds EW, Sithisarn T, Traxel SJ, Patwardhan AR, Crawford TN, Mendiondo MS, Bada HS. Autonomic nervous system function following prenatal opiate exposure. Front Pediatr 2013; 1:27. [PMID: 24400273 PMCID: PMC3864192 DOI: 10.3389/fped.2013.00027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 09/27/2013] [Indexed: 11/13/2022] Open
Abstract
In utero exposure to opiates may affect autonomic functioning of the fetus and newborn. We investigated heart rate variability (HRV) as a measure of autonomic stability in prenatal opiate-exposed neonates (n = 14) and in control term infants (n = 10). Electrocardiographic data during both non-nutritive and nutritive sucking were evaluated for RR intervals, heart rate (HR), standard deviation of the consecutive RR intervals (SDRR), standard deviation of the differences of consecutive RR intervals (SDDRR), and the power spectral densities in low and high frequency bands. In controls, mean HR increased significantly, 143-161 per min (p = 0.002), with a trend toward a decrease in RR intervals from non-nutritive to nutritive sucking; these measures did not change significantly among exposed infants. Compared to controls, exposed infants demonstrated significantly greater HRV or greater mean SDRR and SDDRR during non-nutritive period (p < 0.01), greater mean SDDRR during nutritive sucking (p = 0.02), and higher powers in the low and high frequency bands during nutritive feedings. Our findings suggest that prenatal opiate exposure may be associated with changes in autonomic nervous system (ANS) functioning involving both sympathetic and parasympathetic branches. Future studies are needed to examine the effects of prenatal opiate exposure on ANS function.
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Affiliation(s)
| | - Eric W Reynolds
- Department of Pediatrics, University of Kentucky , Lexington, KY , USA
| | | | - Stuart J Traxel
- Department of Biomedical Engineering, University of Kentucky , Lexington, KY , USA
| | - Abhijit R Patwardhan
- Department of Biomedical Engineering, University of Kentucky , Lexington, KY , USA
| | - Timothy N Crawford
- Department of Biostatistics, College of Public Health, University of Kentucky , Lexington, KY , USA
| | - Marta S Mendiondo
- Department of Biostatistics, College of Public Health, University of Kentucky , Lexington, KY , USA
| | - Henrietta S Bada
- Department of Pediatrics, University of Kentucky , Lexington, KY , USA
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Doyle OM, Korotchikova I, Lightbody G, Marnane W, Kerins D, Boylan GB. Heart rate variability during sleep in healthy term newborns in the early postnatal period. Physiol Meas 2009; 30:847-60. [DOI: 10.1088/0967-3334/30/8/009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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10
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El-Khatib MF. A diagnostic software tool for determination of complexity in respiratory pattern parameters. Comput Biol Med 2007; 37:1522-7. [PMID: 17403521 DOI: 10.1016/j.compbiomed.2007.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Revised: 01/12/2007] [Accepted: 01/30/2007] [Indexed: 11/18/2022]
Abstract
The development and validation of a software that is user friendly and flexible in determining approximate entropy and reflecting complexity in respiratory pattern parameters are presented. The report includes the theory and computational methods for approximate entropy as well as the system description and software architecture. Results for a simulated periodic and regular respiratory pattern as well as for an irregular and complex breathing pattern obtained from a patient receiving mechanical ventilation in the intensive care unit are provided. By providing easy and rapid determination of the approximate entropy, the software enables health care professionals to understand how specific mechanical ventilation settings influence the respiratory pattern for patients receiving mechanical ventilation in the intensive care unit and ultimately identify the reversibility of respiratory diseases and weaning and liberation from mechanical ventilation.
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Affiliation(s)
- Mohamad F El-Khatib
- Department of Anesthesiology, American University of Beirut, School of Medicine, P.O. Box: 11-0236, Beirut 1107-2020, Lebanon.
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Longin E, Gerstner T, Schaible T, Lenz T, König S. Maturation of the autonomic nervous system: differences in heart rate variability in premature vs. term infants. J Perinat Med 2007; 34:303-8. [PMID: 16856820 DOI: 10.1515/jpm.2006.058] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS Heart rate variability (HRV) reveals information on the functional state of the autonomic nervous system (ANS). This study was initiated to assess the physiological- and maturational development of the ANS by comparing HRV data of healthy prematures with term infants. METHODS Short-term recordings of HRV in 39 premature healthy infants (29-35 weeks' gestation) were performed and compared with normative data of term infants. Frequency domain HRV parameters are computed in three frequency bands. RESULTS Gestational age of newborn infants is correlated with HRV. Prematures showed significant lower HRV parameters than term infants. The most significant differences were discerned for HRV parameters reflecting parasympathetic activity, whereas the pulse of the baro-receptor reflex was similar for prematures and term infants at 0.07 Hz (0.1 Hz adults). A respiratory peak in the HF-band according to respiratory sinus arrhythmia (RSA), as is common in adults, was not detected for prematures as it is not detected in term infants. CONCLUSIONS Maturation of the ANS is accompanied by increasing HRV with a pronounced increase of parasympathetic activity. These changes are measurable by short-term recordings. The physiological pulses concerning baroreceptor reflex activity and respiratory modulation were similar in prematures and term infants.
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Affiliation(s)
- Elke Longin
- Children's Hospital, University of Mannheim, Germany.
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Longin E, Schaible T, Demirakca S, Lenz T, König S. Heart rate variability during extracorporeal membrane oxygenation and recovery in severe neonatal disease. Early Hum Dev 2006; 82:135-42. [PMID: 16209914 DOI: 10.1016/j.earlhumdev.2005.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 09/23/2004] [Accepted: 07/06/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Heart rate variability (HRV) reveals information on the functional state of the autonomic nervous system (ANS) in neonates. During severe illness, heart rate variability is impaired. AIM This study was initiated to measure the changes in HRV in neonates during extracorporeal membrane oxygenation (ECMO) and recovery from severe respiratory and circulatory failure. Moreover, we compared our data with HRV data of healthy newborns and we investigated the differences in HRV parameters between ECMO-survivors and non-survivors. STUDY DESIGN This study is of an observational character. We performed short-term recordings of heart rate variability in 14 neonates during ECMO and recovery. We computed time- and frequency-domain HRV parameters. RESULTS ECMO significantly affects time-domain HRV parameters. Severe neonatal illness causes a significant reduction of all calculated HRV parameters; clinical recovery is accompanied by an increase of HRV. In comparison with normative data of healthy newborns, however, HRV remains impaired. The ECMO-development ratio separated the non-survivors from the survivors during ECMO therapy. CONCLUSIONS During severe neonatal illness, HRV is impaired. It remains to be clarified whether the impairment of HRV during severe illness can predict the neurological outcome. The ability of the E/D ratio as an HRV parameter to serve as a predictive tool has to be corroborated in larger group of patients.
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Affiliation(s)
- Elke Longin
- Children's Hospital, University of Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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Longin E, Schaible T, Lenz T, König S. Short term heart rate variability in healthy neonates: normative data and physiological observations. Early Hum Dev 2005; 81:663-71. [PMID: 16046085 DOI: 10.1016/j.earlhumdev.2005.03.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2001] [Accepted: 03/02/2005] [Indexed: 11/17/2022]
Abstract
BACKGROUND The measurement of heart rate variability (HRV) reveals information on the functional state of the autonomic nervous system (ANS). Moreover, several diseases are known to be accompanied by a reduction in HRV. Currently, there are no data on HRV within larger samples of healthy neonates. AIM This study was initiated to establish normative data of HRV parameters and to assess physiological observations in healthy newborn infants. STUDY DESIGN We performed 10 min recordings of HRV in 80 healthy neonates. We computed time domain parameters. Furthermore power spectrum analysis was calculated by Fourier Transformation in 3 frequency bands. The total power as well as the peak frequencies was estimated for each band. RESULTS The normative data of each HRV parameter for healthy newborns are presented as mean, standard deviation and the 5th and 95th percentiles. Increasing postnatal age is accompanied by a significant (p<0.05) elevation of HRV parameters. Baroreceptor loop fluctuations were delayed from 0.1 Hz (adults) to 0.07 Hz in healthy newborns. A respiratory peak according to respiratory sinus arrhythmia (RSA) as it is common in adults was not detectable. CONCLUSIONS Normative data of HRV allows the interpretation of clinical data in neonatal diseases affecting the ANS. Moreover, we observed physiological deviations in healthy newborns in comparison to adults.
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Affiliation(s)
- Elke Longin
- University Children's Hospital, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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de Beer NAM, Andriessen P, Berendsen RCM, Oei SG, Wijn PFF, Oetomo SB. Customized spectral band analysis compared with conventional Fourier analysis of heart rate variability in neonates. Physiol Meas 2005; 25:1385-95. [PMID: 15712717 DOI: 10.1088/0967-3334/25/6/004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A customized filtering technique is introduced and compared with fast Fourier transformation (FFT) for analyzing heart rate variability (HRV) in neonates from short-term recordings. FFT is classically the most commonly used spectral technique to investigate cardiovascular fluctuations. FFT requires stability of the physiological signal within a 300 s time window that is usually analyzed in adults. Preterm infants, however, show characteristics of rapidly fluctuating heart rate and blood pressure due to an immature autonomic regulation, resulting in non-stationarity of these signals. Therefore neonatal studies use (half-overlapping or moving) windows of 64 s length within a recording time of 2-5 min. The proposed filtering technique performs a filtering operation in the frequency range of interest before calculating the spectrum, which allows it to perform an analysis of shorter periods of only 42 s. The frequency bands of interest are 0.04-0.15 Hz (low frequency, LF) and 0.4-1.5 Hz (high frequency, HF). Although conventional FFT analysis as well as the proposed alternative technique result in errors in the estimation of LF power, due to spectral leakage from the very low frequencies, FFT analysis is more sensitive to this effect. The response times show comparable behavior for both the techniques. Applying both the methods to heart rate data obtained from a neonate before and after atropine administration (inducing a wide range of HRV), shows a very significant correlation between the two methods in estimating LF and HF power. We conclude that a customized filtering technique might be beneficial for analyzing HRV in neonates because it reduces the necessary time window for signal stability.
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Affiliation(s)
- N A M de Beer
- Department of Signal Processing Systems, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
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15
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Patural H, Barthelemy JC, Pichot V, Mazzocchi C, Teyssier G, Damon G, Roche F. Birth prematurity determines prolonged autonomic nervous system immaturity. Clin Auton Res 2004; 14:391-5. [PMID: 15666067 DOI: 10.1007/s10286-004-0216-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2003] [Revised: 06/24/2004] [Indexed: 10/25/2022]
Abstract
Because of its multiple involvement in physiological processes, autonomic nervous system (ANS) activity, a key regulator of homeostatic control, demonstrates a progressive increase during pregnancy. The profile of its maturation, mainly in the parasympathetic arm, in premature or full term infants, may help us to better understand its pathophysiological role. We prospectively evaluated ANS maturity in a group of 23 premature (PREM) infants at their theoretical term age and in 8 full term (FT) newborns. All recordings were registered close to the theoretical full term period (from 38 to 41 weeks) for the PREM group and during the first week of life for the FT newborns. Polygraphic recordings, EEG monitoring associated with visual clinical control, and Holter ECG, were performed simultaneously. ANS indices were then calculated during quiet sleep periods, using Wavelet transform of RR (beat to beat) intervals. High frequency components were found to be significantly lower in the PREM than in the FT group (p<0.05). Furthermore, at theoretical full term age, the greater the prematurity, the lower was parasympathetic activity. Because it is easy, monitoring of parasympathetic activity may help us to understand autonomic maturation and its clinical prognostic implications.
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Affiliation(s)
- H Patural
- Service de réanimation pédiatrique et néonatologie, Hôpital Nord C. H. U., Saint-Etienne 42055 cedex 02, France.
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16
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Beuchée A, Pladys P, Senhadji L, Bétrémieux P, Carré F. Beat-to-beat blood pressure variability and patent ductus arteriosus in ventilated, premature infants. Pflugers Arch 2003; 446:154-60. [PMID: 12739152 DOI: 10.1007/s00424-002-0961-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2002] [Revised: 07/17/2002] [Accepted: 09/19/2002] [Indexed: 10/22/2022]
Abstract
The aim of the present study was to test the hypothesis that a relationship exists between respiratory-induced blood pressure variability (BPV) and transductal shunting in premature infants with respiratory distress. Ten premature infants (27-32 weeks gestation) with respiratory distress ventilated in the synchronised, positive-pressure mode were examined. The interrelations between blood pressure and transthoracic impedance were described using time and frequency domain analysis. Haemodynamic effects of left-to-right transductal shunting were assessed using Doppler echocardiography (ratio of diastolic flow to systolic flow in the subdiaphragmatic aorta). The dependence of blood pressure fluctuations on the respiratory cycle was seen consistently in both time-domain and cross-spectral analysis. The amplitude of these fluctuations varied between infants. In the time domain, the beat-to-beat pressure difference was 0.69-4.1 mmHg for diastolic and 0.99-5.24 mmHg for systolic blood pressure. There was a positive linear relationship between the respiratory-related BPV indicators and the extent of left-to-right transductal shunting ( r=0.86 for diastolic and 0.80 for systolic pressure, P<0.01). Respiratory-related BPV was not correlated to the indicators of left ventricle preload. It is concluded that respiratory related BPV involves both diastolic and systolic blood pressure and is correlated to the magnitude of left-to-right transductal shunting in the population studied.
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Affiliation(s)
- Alain Beuchée
- Department of Paediatrics, Neonatal Intensive Care Unit, Pavillon Le Chartier, CHU Pontchaillou, 35033, Rennes Cedex 09, France.
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Shen HN, Lin LY, Chen KY, Kuo PH, Yu CJ, Wu HD, Yang PC. Changes of heart rate variability during ventilator weaning. Chest 2003; 123:1222-8. [PMID: 12684315 DOI: 10.1378/chest.123.4.1222] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Despite the recognition that ventilator weaning is associated with a change in autonomic nervous system activity, there has not been any report concerning the change of heart rate variability (HRV), a reliable method to detect autonomic nervous system activity, in patients during weaning. The aim of this study was to investigate the change of autonomic nervous system activity during ventilator weaning by HRV analysis. DESIGN Prospective study. SETTING A 16-bed medical ICU of a tertiary university hospital. PATIENTS Twenty-four patients receiving mechanical ventilation were included. Twelve patients with successful extubation after a spontaneous breathing trial (SBT) [T-piece trial] were classified as the success group; otherwise, the patients were placed in the failure group. INTERVENTIONS None. MEASUREMENTS AND RESULTS Variables, including the total power (TP), and the high-frequency (HF) and low-frequency (LF) components of HRV, were measured in three phases: assist/control mandatory ventilation, pressure support ventilation (PSV), and SBT. While shifting from PSV to SBT, the HRV components decreased significantly in the failure group (TP, p = 0.025; LF, p = 0.007; HF, p = 0.031), but not in the success group. CONCLUSIONS By HRV analysis, reduced HRV and vagal withdrawal of the autonomic nervous system activity are the main changes in patients with weaning failure.
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Affiliation(s)
- Hsiu-Nien Shen
- Department of Internal Medicine, En-Chu-Kong Hospital, Taipei, Taiwan
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18
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Eiselt M, Zwiener U, Witte H, Curzi-Dascalova L. Influence of Prematurity and Extrauterine Development on the Sleep State Dependent Heart Rate Patterns. Einfluss von Fruhgeburtlichkeit und extrauteriner Entwicklung auf schlafstadienabhangige Herzfrequenzveranderungen. SOMNOLOGIE 2002. [DOI: 10.1046/j.1439-054x.2002.02189.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Oberlander T, Saul JP. Methodological considerations for the use of heart rate variability as a measure of pain reactivity in vulnerable infants. Clin Perinatol 2002; 29:427-43. [PMID: 12380467 DOI: 10.1016/s0095-5108(02)00013-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Measures of HR and HRV offer multiple indices of reactivity to painful events. These measures are particularly helpful in preterm and ill infants where distress signals are often nonspecific and ambiguous. HR is easy to acquire, and a variety of widely used techniques are available for processing it. In general, the neuroanatomic and neurophysiologic bases for pain perception are in place even in the most preterm infant and produce patterns of HR and HRV responses that are similar across multiple settings. Developmental and experiential factors related to preterm birth, however, may affect these HR responses. Furthermore, evaluation of ill infants in an NICU setting adds multiple contextual factors that potentially influence HR and HRV and alter their specificity as measures of pain. In some cases, it may appear that pain reactivity is reduced when, in fact, HR reactivity is only an expression of the biologic capacity to produce a response, not the presence of a response itself. The nature of the setting and the infant's health, developmental stage, and behavioral state all contribute to potentially altering HR responses to painful events in this setting. Thus, the methodology used and its application must be flexible. A variety of HRV analysis techniques may be needed to identify a variety of response patterns and mechanisms that influence pain reactivity. Furthermore, careful selection of HR epochs for stationarity, an understanding of the potential discordance between biologic and behavioral measures, the effects of medication, and an accounting for developmental differences that occur during a typical NICU course are all critical factors for investigators to be aware of. Understanding cardiovascular reactivity as a measure of response to painful events in vulnerable infants requires ongoing work.
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Affiliation(s)
- Tim Oberlander
- Division of Developmental Pediatrics, University of British Columbia, Centre for Community Child Health Research, Children's and Women's Health Centre of B.C., 4480 Oak Street, Vancouver, B.C. V6N 2H4, Canada.
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Patzak1 A, Mrowka1 R, Springer2 S, Eckardt3 T, Ipsiroglu4 OS, Erler5 T, Hofmann6 S, Gramse7 V, Projektgruppe Herzfrequenzvariabili, AG Padiatrie der Deutschen Gesellsc. Empfehlungen fur die Bestimmung der -Herzfrequenzvariabilitat im padiatrischen Schlaflabor. Heart Rate Variability in the Paediatric Sleep Laboratory - Recommendations for -Measurement and Analysis. SOMNOLOGIE 2002. [DOI: 10.1046/j.1439-054x.2002.02002.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Larsen PD, Galletly DC. Cardioventilatory coupling in heart rate variability: the value of standard analytical techniques. Br J Anaesth 2001; 87:819-26. [PMID: 11878681 DOI: 10.1093/bja/87.6.819] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In a group of spontaneously breathing anaesthetized subjects, we examined the ability of simple spectral and non-linear methods to detect the presence of cardioventilatory coupling in heart rate time series. Using the proportional Shannon entropy (H(RI-1)) of the RI(-1) interval (interval between inspiration and the preceding ECG R wave) as a measure of coupling, we found no correlation between H(RI-1) and either the fractal dimension or approximate entropy of the heart rate time series. We also observed no difference in the distribution of heart rate variability (HRV) spectral power in three frequency ranges (high, 0.15-0.45 Hz; low, 0.08-0.15 Hz; very low, 0.02-0.08 Hz) between uncoupled epochs and coupling patterns I, III and IV. Because of its association with low breathing frequencies, pattern II coupling epochs showed exaggerated low-frequency power as the high-frequency 'respiratory' peak fell into the low-frequency range. We conclude that coupling pattern is largely independent of autonomic tone and that these standard methods of HRV analysis are limited in their ability to detect the presence of cardioventilatory coupling in heart rate time series.
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Affiliation(s)
- P D Larsen
- Section of Anaesthesia, Wellington School of Medicine, New Zealand
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22
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Morison SJ, Grunau RE, Oberlander TF, Whitfield MF. Relations between behavioral and cardiac autonomic reactivity to acute pain in preterm neonates. Clin J Pain 2001; 17:350-8. [PMID: 11783816 PMCID: PMC1852479 DOI: 10.1097/00002508-200112000-00010] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to assess relations and concordance between behavioral and physiologic reactivity to pain in preterm neonates at 32 weeks postconceptional age as a function of gestational age at birth. SETTING Level III neonatal intensive care unit. DESIGN/PATIENTS The study group comprised 136 preterm neonates (mean [range] birthweight, 1,020 g [445-1,500 g]: gestational age at birth, 28 weeks [23-32 weeks]) separated into three groups according to gestational age at birth as follows: 23 to 26 weeks (n = 48), 27 to 29 weeks (n = 52), and 30 to 32 weeks (n = 36). OUTCOME MEASURES Reactivity to routine blood collection at 32 weeks postconceptional age was assessed using bedside-recorded behavioral and autonomic measures. Coders who were blinded to the study design scored behavioral responses (facial activity using the Neonatal Facial Coding System, sleep/waking state, and finger splay). Autonomic reactivity was assessed by change in heart rate and spectral analysis of heart rate variability (change in low-frequency and high-frequency power, and the ratio of low-frequency to high-frequency power during blood collection). RESULTS Facial activity and state correlated moderately with change in heart rate across gestational age groups (r = 0.41-0.62). Facial activity and state did not correlate significantly with change in low-frequency and high-frequency power, or the ratio of low-frequency to high-frequency power (r = 0.00-0.31). Finger splay did not correlate with any autonomic recording (r = 0.03-0.41). Concordance between established biobehavioral measures of pain revealed individual differences. Although some neonates showed high behavioral but low physiologic reactivity, other neonates displayed the opposite reaction; however, the majority displayed concordant reactions. CONCLUSIONS The study findings confirm the value of measuring domains independently, especially in neonates born at a very young gestational age.
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Affiliation(s)
- S J Morison
- Center for Community Health and Health Evaluation Research, British Columbia Research Institute For Children's and Women's Health, Vancouver, Canada.
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23
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Abstract
Sudden infant death syndrome (SIDS) is more prevalent in infants of smokers and may involve subtle alterations in autonomic control mechanisms. Autonomic function can be assessed using blood pressure responses to a passive head-up tilt and power spectral analysis of heart rate variability. This study aimed to determine if maternal smoking altered infants' responses to head-up tilt. Blood pressure and heart rate responses to a passive 70 degrees head-up tilt were compared in infants of smokers and non-smokers at 2-3 days and 3 months of age. There were no significant differences between groups in power spectral indices. At 2-3 days, the systolic pressure response to tilt was significantly different between groups (P<0.01). In infants of smokers, systolic pressure decreased by a mean (S.E.) of 7.7(1.1) mmHg, whereas in control infants it remained unchanged. At 3 months, systolic pressure in infants of smokers remained unchanged but increased in control infants by 6.2(2.1) mmHg (P<0.05). These results indicate that maternal smoking alters autonomically mediated cardiovascular responses in the infant.
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Affiliation(s)
- C A Browne
- Perinatal Research Centre, The University of Queensland, Royal Women's Hospital, Brisbane, QLD 4029, Australia.
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24
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Lindh V, Wiklund U, Håkansson S. Assessment of the effect of EMLA during venipuncture in the newborn by analysis of heart rate variability. Pain 2000; 86:247-254. [PMID: 10812254 DOI: 10.1016/s0304-3959(00)00252-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of this study was to investigate the effect of EMLA on the pain response when venipuncture was performed in 60 3-day-old healthy newborns. EMLA/placebo was applied to the back of the baby's hand, following a randomized, double-blind procedure. ECG and crying were recorded during the test. The incidence of crying, heart rate (HR) and spectral analysis of heart rate variability were used to characterize the reaction of the baby to the venipuncture procedure. The occurrence of crying during venipuncture did not differ significantly between the EMLA and the placebo groups. The placebo-treated group showed a statistically significant higher HR, and a decrease in variance (total power) and power in the low-frequency band (0.02-0.15 Hz) when compared with the EMLA group. We conclude that EMLA decreases the stress response during venipuncture in newborn infants.
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Affiliation(s)
- Viveca Lindh
- Departments of Pediatrics, University Hospital, SE-90185 Umeå, Sweden Departments of Clinical Physiology and Biomedical Engineering, University Hospital, SE-90185 Umeå, Sweden
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25
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Abstract
Identifying variables predictive of neurobehavioural sequelae is a key objective in the study of high-risk neonates. Examination of heart rate variability (HRV) characteristics may be a finer discriminator of the neonate's response to physiologic stressors than the mean heart rate. The energy entropy of the heart beat tachogram, computed in four different domains, was used to quantify the HRV in 13 preterm neonates. The entropies of energies were computed from 1024 interbeat time intervals obtained once per week from 26 to 35 weeks postconceptional age (PCA). The energy entropy computed in three of the domains, like the standard deviation of intervals, distinguished between the 10 neonates that were measured at 35 weeks PCA with 100% specificity and 67% sensitivity, but did not distinguish between healthy and unhealthy neonates at earlier ages. The findings suggest that energy entropy may be a discerning measure of physiologic stress in the preterm infant, although future research is needed to refine the test and determine statistical significance.
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Affiliation(s)
- M T Verklan
- University of Texas, Health Science Center at Houston 77030, USA.
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26
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Engoren M. Approximate entropy of respiratory rate and tidal volume during weaning from mechanical ventilation. Crit Care Med 1998; 26:1817-23. [PMID: 9824073 DOI: 10.1097/00003246-199811000-00021] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the effects of respiratory failure on respiratory rate pattern and tidal volume pattern. DESIGN Prospective, clinical study. SETTING Cardiovascular intensive care unit. PATIENTS Ten patients within 12 hrs of cardiac surgery, and 21 patients who required prolonged (>7 days) mechanical ventilation. INTERVENTIONS Patients were placed on spontaneous ventilation for weaning trials. MEASUREMENTS AND MAIN RESULTS During spontaneous ventilation, each breath's instantaneous respiratory rate and tidal volume were recorded for later analysis. Approximate entropy (ApEn) was calculated for respiratory rate and tidal volume series of the terminal 1000 breaths on each spontaneous ventilation trial in series of 100, 300, and 1000 breaths. Ten patients (controls) were studied and extubated within 12 hrs of cardiac surgery. The other 21 patients were studied during attempts to wean them from mechanical ventilation. These patients passed (Group V-Pass) 59 and failed (Group V-Fail) 14 weaning trials. Mean tidal volume did not vary between groups, but respiratory rate increased progressively from the control group to Group V-Pass to Group V-Fail (p < .017). Conversely, approximate entropy of respiratory rate (ApEn-RR) did not vary among the three groups at any time series length, but approximate entropy of tidal volume (ApEn-VT) increased from the control group to Group V-P (p< .017) to Group V-F (p< .017) at all time series lengths. ApEn-VT was very specific but only moderately sensitive at identifying respiratory failure. CONCLUSION Respiratory failure causes tidal volume patterns to become increasingly irregular, but increasing respiratory rate has no effect on respiratory rate pattern.
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Affiliation(s)
- M Engoren
- Department of Anesthesiology, Saint Vincent Mercy Medical Center, Toledo, OH, USA
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27
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Pincus SM, Minkin MJ. Assessing sequential irregularity of both endocrine and heart rate rhythms. Curr Opin Obstet Gynecol 1998; 10:281-91. [PMID: 9719878 DOI: 10.1097/00001703-199808000-00001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The quantification of subtle patterns in sequential data, and their changes, has considerable potential utility both in analysis of hormonal secretory dynamics, and of fetal heart rate rhythms. Approximate entropy, a recently developed statistic quantifying serial irregularity, has been applied in both these settings, and has yielded a number of new findings. Among endocrine applications, approximate entropy increases with increasing age for luteinizing hormone and follicle stimulating hormone, for both women and men, indicating greater irregularity (more apparently random dynamics) in the older groups; for the luteinizing hormone-testosterone axis, both irregularity and asynchrony increases accompany advancing age for men. These findings produce a means to potentially predict time until menopause onset, the efficacy of infertility drugs, and also provide firm quantitative support of a partial male menopause. In fetal monitoring, antepartum, and postnatal heart rate studies, approximate entropy consistently detected subtle shifts in heart rate rhythmicity, with greater regularity clinically corresponding to compromised physiology in all settings. Both the capability of approximate entropy to quantify rhythm changes undiscernible by auscultation, and a continuum interpretation linking per-individual antepartum, perinatal, and postnatal heart rate analyses provide considerable potential enhancement to the present clinical utility of fetal monitoring.
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Affiliation(s)
- S M Pincus
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut, USA
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Lindh V, Wiklund U, Sandman PO, Håkansson S. Assessment of acute pain in preterm infants by evaluation of facial expression and frequency domain analysis of heart rate variability. Early Hum Dev 1997; 48:131-42. [PMID: 9131314 DOI: 10.1016/s0378-3782(96)01851-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In ten preterm infants (postconceptional age 27-35 weeks) facial expression and heart rate variability (HRV) were investigated during three situations: (a) the infant at rest in its crib or incubator, (b) provocation of the withdrawal flexor reflex by application of von Frey's hairs, and (c) lancing and squeezing for blood sampling. Video recordings of facial expressions, mixed at random, were categorised as the baby being either undisturbed, disturbed or in pain and a detailed scoring for each situation was performed. Mean heart rate (HR) was calculated and power spectral analysis was assessed on data from segments of 45-s duration from the three procedures. Flexor withdrawal did not evoke visual signs of pain or influence HRV, but caused a slight increase in HR. The lancing and squeezing of the heel evoked a facial expression of pain in all infants. The HR increased and a reduction in both total HRV and power in the low frequency band of the HRV spectrum was seen during blood sampling. The differentiation between painful and non-painful procedures was more apparent when principal component analysis of HRV was applied.
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Affiliation(s)
- V Lindh
- Department of Pediatrics, University Hospital, Umeå, Sweden.
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Groome LJ, Mooney DM, Bentz LS, Singh KP. Spectral analysis of heart rate variability during quiet sleep in normal human fetuses between 36 and 40 weeks of gestation. Early Hum Dev 1994; 38:1-9. [PMID: 7982383 DOI: 10.1016/0378-3782(94)90045-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Respiratory sinus arrhythmia (RSA) is a clinical manifestation of the parasympathetic nervous system which can be identified in the high-frequency region of the heart rate variability (HRV) power spectrum. The purpose of this study was to determine the relative contribution of RSA to overall HRV for human fetuses in quiet sleep. The study population consisted of 13 normal human fetuses between 36 and 40 weeks of gestation for whom data were collected during spontaneous breathing and normally occurring apneic periods. Fetal breathing was monitored continuously using real-time sonography. The fetal electrocardiogram was captured transabdominally in 3-min blocks at a rate of 833 Hz and fetal R-waves were extracted from the raw signal using adaptive signal processing techniques. Fetal behavioral state was determined at the beginning and end of each 3-min data collection period. The fetal R-wave interbeat intervals (IBIs) were converted to equally-spaced, time-based data, and linear detrending of the time series was accomplished by subtracting the mean heart period from each weighted IBI. Total power (TP, 0.0-2.5 Hz) was divided into RSA (0.4-1.0 Hz), high-frequency (HF, 0.2-2.5 Hz), low-frequency (LF, 0.04-0.2 Hz), and very-low-frequency (VLF, 0.0-0.04 Hz) regions, and the power densities were summed to determine the absolute power for each frequency component. A total of 81 3-min blocks (mean per subject 6.3, range 2-14) were available for analysis. Eleven (85%) of 13 fetuses demonstrated a HF peak during fetal breathing, and RSA accounted for approximately 20% of the TP.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L J Groome
- Department of Obstetrics and Gynecology, University of South Alabama, Mobile 36617
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30
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Abstract
A method for continuous monitoring and recording of neonatal heart rate variability (HRV) and further physiological parameters in the intensive care unit is presented: 16 neonatal monitors were connected via two input/output processor boards to a personal computer. Patient data were processed by special software. Every day a 24-h record was printed for each infant, including a continuous registration of long-term (LTV) and short-term variability (STV) of heart rate along with baseline heart rate, respiratory rate, body temperature, temperature of the incubator and transcutaneous partial pressures of oxygen and carbon dioxide (tcPO2 and tcPCO2). For each parameter automatic artefact removal was implemented. Median and percentiles were computed once daily from all valid values. The influence of gestational and postnatal age and of respiratory distress syndrome (RDS) on HRV was studied in 105 preterm infants below 33 weeks of gestation during the first 7 days of life. An increase of both LTV and STV was seen with increasing gestational and postnatal age. In infants with RDS a decreased LTV was found in relation to the severity of the disease. HRV was also decreased in impaired brain function due to intraventricular hemorrhage, asphyxia or sedative treatment.
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Affiliation(s)
- V Prietsch
- Children's Hospital, Philipps-Universität Marburg, Germany
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31
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Van Ravenswaaij-Arts C, Hopman J, Kollée L, Stoelinga G, Van Geijn H. Spectral analysis of heart rate variability in spontaneously breathing very preterm infants. Acta Paediatr 1994; 83:473-80. [PMID: 8086722 DOI: 10.1111/j.1651-2227.1994.tb13062.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The influence of maturation, sleep state and respiration on heart rate variability was studied in 16 spontaneously breathing preterm infants (< 33 weeks). ECG, respiratory impedance curve and movements were recorded four times a day, during the first three days of life. The power content of selected frequency bands of the R-R interval power spectrum, as well as respiratory frequency and breath amplitude oscillation frequency, were calculated for 3-min periods. An increase in low-frequency heart rate variability with gestational age was found. High-frequency variability increased during early postnatal life. Sleep state influenced very low-frequency heart rate variability. The amount of respiratory sinus arrhythmia and breath amplitude sinus arrhythmia was determined mainly by respiratory rate and breath amplitude oscillation frequency, respectively. The influences of gestational and postnatal age on heart rate variability might be due to an increase in sympathetic tone before birth and a change in parasympathetic-sympathetic balance after birth. Respiration has an important influence on heart rate variability, even in very preterm infants.
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Metsälä TH, Siimes AS, Antila KJ, Tuominen J, Välimäki IA. Computer analysis of heart rate variation and breathing movements in fetal lambs. Med Biol Eng Comput 1993; 31:221-8. [PMID: 8412374 DOI: 10.1007/bf02458040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A quantitative method for studying the frequency-specific relationships between heart rate (HR) and fetal breathing movements (FBM) was developed. The reactivity of periodic HR variation in relation to FBM was investigated by means of power spectral analysis. Seven fetal lambs were studied during the third trimester of gestation using a chronic animal model. HR variability increased at the rate of FBM, as shown by an increase of spectral density at > 0.35 Hz in the HR autospectrum and in the cross-spectrum of HR and respirogram, as well as by an increase in the short-term variability index CVS. FBM were associated with the increased HR variation in all but the lowest frequency bands (0.07-1.0 Hz). Although respiratory sinus arrhythmia was found, only 10 per cent of the total HR variability and 25 per cent of the joint-density of HR and respirogram appeared at > 0.35 Hz during FBM. The greatest variation in both the HR and respirogram spectra appeared at < 0.07 Hz. Although the low-frequency variability of HR and respirogram was simultaneous, it was on the whole not synchronised. The existence of multiple control systems that simultaneously link the cardiac and respiratory control mechanisms to each other in the fetal lamb is postulated.
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Affiliation(s)
- T H Metsälä
- Cardiorespiratory Research Unit, University of Turku, Finland
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33
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Thompson CR, Brown JS, Gee H, Taylor EW. Heart rate variability in healthy term newborns: the contribution of respiratory sinus arrhythmia. Early Hum Dev 1993; 31:217-28. [PMID: 8444140 DOI: 10.1016/0378-3782(93)90197-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Cardiorespiratory interactions in healthy full term newborns were investigated. Spectral analysis was used on heart rate and breathing data from 22 neonates 2-5 days old to reveal coincident frequencies in the breathing and heart rate variability (HRV) spectra, thus identifying respiratory sinus arrhythmia (RSA). The spectral description of HRV in healthy term newborns revealed a consistent and distinct RSA feature, with a mean contribution of over 30%. The contribution of RSA to HRV was dependent on breathing frequency and absolute RSA power. The mechanisms that produce this cardiorespiratory interaction are considered to be functionally active in the healthy term neonate.
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Affiliation(s)
- C R Thompson
- Perinatal Physiology Group, School of Biological Sciences, University of Birmingham, Edgbaston, UK
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Hedman AE, Hartikainen JE, Tahvanainen KU, Hakumäki MO. Power spectral analysis of heart rate and blood pressure variability in anaesthetized dogs. ACTA PHYSIOLOGICA SCANDINAVICA 1992; 146:155-64. [PMID: 1442131 DOI: 10.1111/j.1748-1716.1992.tb09404.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Short-term oscillation of heart rate and blood pressure are mainly regulated by the automatic nervous system. It has been proposed that non-neural factors, such as changes in intrathoracic pressure, can strongly modulate this rhythmicity. Our aim was to evaluate the effect of changing intrathoracic pressure and central autonomic nervous activity on heart rate and blood pressure variability. Evaluation was performed by using spectral analysis techniques with autoregressive modelling. The variability in heart rate and blood pressure remained in animals with open chest or paralysed respiratory muscles. After vagotomy, the variability in heart rate decreased, but not that of blood pressure. Total spinal anaesthesia elicited a decrease in the variability in blood pressure. The pharmacological blockade of alpha- and beta-receptors further decreased both variabilities. It was concluded that in anaesthetized dogs heart rate and blood pressure variability are mainly of central origin and non-neural factors have only minor effect on these central rhythms. High (> 0.15 Hz), medium (0.07-0.15 Hz) and, obviously low (0.00-0.07 Hz) frequency variations in heart rate are mostly mediated vagally. In blood pressure, medium and obviously low frequency variations are modulated by sympathetic nervous system, whereas high frequency variations are secondary to the heart rate variation.
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Affiliation(s)
- A E Hedman
- Department of Physiology, University of Kuopio, Finland
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35
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Curzi-Dascalova L. Physiological correlates of sleep development in premature and full-term neonates. Neurophysiol Clin 1992; 22:151-66. [PMID: 1630415 DOI: 10.1016/s0987-7053(05)80751-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Differentiation of motor and automatic function control during different sleep states appears early in human ontogeny. Time of first appearance, magnitude of between-state differences and modifications with age depend on which particular parameters are considered. For some parameters, significant between-state differences appear at 31 weeks conceptional age (wk CA). For nearly all parameters, this difference is clear from 35 wk CA onwards. The analysis presented herein is based on studies of body movements, spontaneous skin potential responses, respiratory characteristics, heart rate and heart rate variability, and correlations between different functions. It examines clinically and neurologically normal premature and full-term neonates of 28-41 wk CA.
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Affiliation(s)
- L Curzi-Dascalova
- INSERM, CJF 89-09, Laboratoire de physiologie, Hôpital Antoine Béclère, Clamart, France
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Clairambault J, Curzi-Dascalova L, Kauffmann F, Médigue C, Leffler C. Heart rate variability in normal sleeping full-term and preterm neonates. Early Hum Dev 1992; 28:169-83. [PMID: 1587227 DOI: 10.1016/0378-3782(92)90111-s] [Citation(s) in RCA: 94] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
To assess maturation of the Autonomic Nervous System (ANS) and sleep states, Heart Rate Variability (HRV) was studied in 24 healthy sleeping newborns, aged from 31 to 41 weeks, conceptional age (CA). Spectral analysis of the interbeat interval (RR) signal, was performed by Short-Time Fourier Transform, in three frequency bands: high (HF), of purely vagal origin, mid (MF), and low (LF), vagal and sympathetic, thus allowing evaluation of both branches of the ANS, observed in Active Sleep (AS = REM Sleep) and in Quiet Sleep (QS = nREM Sleep). Principal Component Analysis, Discriminant Analysis, and hypothesis tests were used to investigate the evolution of spectral variables and their relation with sleep states. HF, MF, LF, and mean RR all increased with age; the differences from the premature to the full-term group, were more marked, as a whole, in AS than in QS. HF showed the highest increase from the premature (31-36 weeks CA) to the intermediate (37-38) group, whereas LF showed equal differences from the premature to the intermediate, and from the intermediate to the full-term (39-41) groups. These results suggest a steep increase in vagal tone at 37-38 weeks CA, with stability afterwards, and a more regular increase in sympathetic tone from 31 to 41 weeks CA.
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van Ravenswaaij-Arts CM, Hopman JC, Kollée LA, van Amen JP, Stoelinga GB, van Geijn HP. Influences on heart rate variability in spontaneously breathing preterm infants. Early Hum Dev 1991; 27:187-205. [PMID: 1802671 DOI: 10.1016/0378-3782(91)90194-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To investigate the influence of maturational and physiological factors on heart rate variability in spontaneously breathing very preterm infants (n = 29) a multiparametric study was performed during the first 3 days of life in infants born at a gestational age below 33 weeks. Four times a day, RR-intervals, respiration curve and rate, transcutaneously measured blood gases and observed body movements were recorded while the infants were asleep. All data were stored simultaneously in a micro-computer. Non-invasively measured blood pressure and patency of the ductus arteriosus were documented as well. Four sets of short- (STV) and long term variability (LTV) indices were calculated. Both STV and LTV appeared to be significantly influenced by conceptional and postnatal age in the appropriate for gestational age infants. LTV was influenced by the behavioural state and body movements. During state coincidence 2 ('active sleep') LTV was influenced by respiratory rate and the variations in transcutaneous PO2. An effect of blood pressure or ductus patency could not be demonstrated.
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38
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van Ravenswaaij-Arts CM, Hopman JC, Kollée LA, van Amen JP, Stoelinga GB, van Geijn HP. The influence of respiratory distress syndrome on heart rate variability in very preterm infants. Early Hum Dev 1991; 27:207-21. [PMID: 1802672 DOI: 10.1016/0378-3782(91)90195-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In a multi-parametric study the influence of pathological neonatal conditions on heart rate variability was investigated in 60 preterm infants born at a gestational age below 33 weeks. Measurements were performed during the first 3 days of life. Four times a day, RR-intervals, respiration curve and rate, transcutaneously measured blood gases and observed body movements were recorded while the infants were asleep. All data were stored simultaneously in a micro-computer. Severity of respiratory distress syndrome (RDS), patency of ductus arteriosus and periventricular haemorrhage were documented as well. Four sets of short- (STV) and long-term variability (LTV) indices were calculated. Severe RDS was associated with a significant decrease in LTV. The influence of RDS on LTV persisted after correction for conceptional age, postnatal age, behavioural state and variations in respiratory rate and in transcutaneous PO2. Infants with a symptomatic patent ductus arteriosus had lower LTV than controls with the same severity of RDS. STV was predominantly influenced by postnatal and conceptional age, and tended to be lower in infants with periventricular haemorrhage.
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39
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Pincus SM, Gladstone IM, Ehrenkranz RA. A regularity statistic for medical data analysis. J Clin Monit Comput 1991; 7:335-45. [PMID: 1744678 DOI: 10.1007/bf01619355] [Citation(s) in RCA: 520] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A new statistic has been developed to quantify the amount of regularity in data. This statistic, ApEn (approximate entropy), appears to have potential application throughout medicine, notably in electrocardiogram and related heart rate data analyses and in the analysis of endocrine hormone release pulsatility. The focus of this article is ApEn. We commence with a simple example of what we are trying to discern. We then discuss exact regularity statistics and practical difficulties of using them in data analysis. The mathematic formula development for ApEn concludes the Solution section. We next discuss the two key input requirements, followed by an account of a pilot study successfully applying ApEn to neonatal heart rate analysis. We conclude with the important topic of ApEn as a relative (not absolute) measure, potential applications, and some caveats about appropriate usage of ApEn. Appendix A provides example ApEn and entropy computations to develop intuition about these measures. Appendix B contains a Fortran program for computing ApEn. This article can be read from at least three viewpoints. The practitioner who wishes to use a "black box" to measure regularity should concentrate on the exact formula, choices for the two input variables, potential applications, and caveats about appropriate usage. The physician who wishes to apply ApEn to heart rate analysis should particularly note the pilot study discussion. The more mathematically inclined reader will benefit from discussions of the relative (comparative) property of ApEn and from Appendix A.
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Affiliation(s)
- S M Pincus
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
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Okken A. Postnatal adaptation in thermoregulation. J Perinat Med 1991; 19 Suppl 1:67-73. [PMID: 1779399 DOI: 10.1515/jpme.1991.19.s1.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- A Okken
- Department of Pediatrics, University Hospital, Groningen, The Netherlands
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Antila KJ, Välimäki IA, Mäkelä M, Tuominen J, Wilson AJ, Southall DP. Heart rate variability in infants subsequently suffering sudden infant death syndrome (SIDS). Early Hum Dev 1990; 22:57-72. [PMID: 2364905 DOI: 10.1016/0378-3782(90)90080-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
To study the role of the autonomic cardiovascular control in SIDS the heart rate variability (HRV) was analysed from 24 tape recordings made from a prospective population-based study on 16 term and one preterm infant suffering SIDS and compared to similar data on 23 control infants matched on birthweight, gestation and postnatal age. The number of regular breathing segments was lower in the SIDS cases than in controls (P = 0.02). No significant differences were found between the SIDS cases and their controls for average heart rate, median breathing rate, indices of overall and beat-to-beat HRV. Neither were significant intergroup differences found when the subjects were divided into neonatal and postneonatal subgroups. Analysis of HRV by power-spectral techniques did not show any significant differences between SIDS cases and controls for the general distribution of power or for the respiratory HRV. Analysis of HRV did not differentiate infants destined to die of SIDS from surviving controls in the same population.
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Affiliation(s)
- K J Antila
- Cardiorespiratory Research Unit, University of Turku, Finland
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van Ravenswaaij-Arts CM, Hopman JC, Kollée LA, Stoelinga GB. The influence of physiological parameters on long term heart rate variability in healthy preterm infants. J Perinat Med 1990; 18:131-8. [PMID: 2366134 DOI: 10.1515/jpme.1990.18.2.131] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The instantaneous heart rate shows a variation around the mean heart rate caused by cardioregulatory mechanisms which are mediated through the sympathetic and vagal autonomic nervous system. To gain more insight into the influence of physiological parameters on neonatal heart rate variability a study was performed in four healthy preterm newborns during the first five days of life. Instantaneous heart rate, respiration rate, transcutaneous pO2, blood pressure and behaviour were recorded during 40 minutes four times a day. Long term heart rate variability was calculated as the difference between p95 and p5 of instantaneous heart rate values sampled during three minutes. A clear relationship between long term variability and age (maturity of the autonomic nervous system), respiration rate (respiratory sinus arrhythmia or a tidal volume mediated effect) and behaviour (increase of sympathetic tone during REM sleep) was found. No influence of blood pressure, heart rate, and transcutaneous pO2 within physiological ranges could be detected. The relative influence of the different physiological parameters on heart rate variability has to be established before the value of heart rate variability as a monitoring tool in neonatal intensive care can be investigated.
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