Abstract
Background
Cardiorespiratory stability of preterm infants is a prerequisite for discharge from the neonatal intensive care unit (NICU) but very difficult to predict. We aimed to assess whether characterizing heart rate fluctuation (HRF) within the first days of life has prognostic utility.
Methods
We conducted a prospective cohort study in 90 preterm infants using a previously validated surface diaphragmatic electromyography (sEMG) method to derive interbeat intervals. We characterized HRF by time series parameters including sample entropy (SampEn) and scaling exponent alpha (ScalExp) obtained from daily 3-h measurements. Data were analyzed by multivariable, multilevel linear regression.
Results
We obtained acceptable raw data from 309/330 sEMG measurements in 76/90 infants born at a mean (range) of 30.2 (24.7–34.0) weeks gestation. We found a significant negative association of SampEn with duration of respiratory support (R2 = 0.53, p < 0.001) and corrected age at discontinuation of caffeine therapy (R2 = 0.35, p < 0.001) after adjusting for sex, gestational age, birth weight z-score, and sepsis.
Conclusions
Baseline SampEn calculated over the first 5 days of life carries prognostic utility for an estimation of subsequent respiratory support and pre-discharge cardiorespiratory stability in preterm infants, both important for planning of treatment and utilization of health care resources.
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Acknowledgements
We thank research nurses K. Gerber, A. Imolesi, A. Padiyath, M. Weber, and N. Wellauer (all affiliated to University Children’s Hospital Basel, Basel, Switzerland) for their help in data acquisition and medical students M. Cremer, A. Gensmer, K. Ledergerber, R. Marchetti, N. Schoenfeld, and N. Schwob (all affiliated to University Children’s Hospital Basel, Basel, Switzerland) for their assistance in video analysis. This study was supported by the Swiss National Science Foundation (No. 141206). The funding body had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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K.J.: Substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; drafting the article; and final approval of the version to be published. A.N.D.: Substantial contributions to conception and design, and interpretation of data; revising the article critically for important intellectual content; and final approval of the version to be published. U.P.F. and B.S.: Substantial contributions to conception and design, analysis and interpretation of data; revising the article critically for important intellectual content; and final approval of the version to be published. S.M.S.: Substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; revising the article critically for important intellectual content; and final approval of the version to be published.
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Jost, K., Datta, A.N., Frey, U.P. et al. Heart rate fluctuation after birth predicts subsequent cardiorespiratory stability in preterm infants. Pediatr Res 86, 348–354 (2019). https://doi.org/10.1038/s41390-019-0424-6
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DOI: https://doi.org/10.1038/s41390-019-0424-6
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