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Detection of pulmonary hypertension in preterm infants with bronchopulmonary dysplasia using oxygen saturation data
Pravitha Ramanand1, Premananda Indic2, Samuel J Gentle3
1Department of Electrical and Computer Engineering, The University of Texas at Tyler, Tyler, TX, USA. pramanand@uttyler.edu.
Insights
Oxygen saturation variability patterns can detect pulmonary hypertension (PH) in preterm infants with bronchopulmonary dysplasia (BPD). This method uses routine data for early PH identification, potentially improving outcomes.
Area of Science:
- Neonatology
- Pediatric Cardiology
- Biomedical Engineering
Background:
- Pulmonary hypertension (PH) is a serious complication in preterm infants with bronchopulmonary dysplasia (BPD), increasing mortality risk.
- Early detection of PH is crucial for timely intervention and improved patient outcomes.
Purpose of the Study:
- To investigate the potential of oxygen saturation (SpO2) variability patterns for early PH detection in preterm infants with BPD.
- To develop and evaluate signal-based measures for identifying PH using routinely collected SpO2 data.
Main Methods:
- Analyzed SpO2 variability using irregularity indices (sample entropy) in preterm infants with BPD and PH versus BPD alone.
- Developed multivariable logistic regression models incorporating entropy-based indices and clinical risk factors (birthweight, sepsis, PDA).
Main Results:
- Distinct SpO2 variability patterns were observed between infants with and without PH.
- The model achieved 82% area under the ROC curve, with 81% accuracy, 78% sensitivity, and 82% specificity for PH detection.
Conclusions:
- Irregularity profiles of SpO2 variability effectively differentiate infants with BPD and PH.
- Routinely collected SpO2 data can be utilized for continuous, bedside PH detection in preterm infants.
Background:
Pulmonary hypertension (PH) complicates the clinical course of bronchopulmonary dysplasia (BPD) in preterm infants, increasing risk of mortality and other morbidities. Early detection of PH may provide the clinical opportunity for earlier initiation of PH targeted therapies.
Methods:
We analyzed variability patterns of oxygen saturation data in 41 preterm infants with BPD and associated PH and 57 infants with BPD alone using irregularity indices to identify PH. Irregularity of oxygen saturation (SpO2) variability time series was characterized by sample entropy over multiple time scales, and characteristic features were derived. Multivariable logistic regression models with entropy-based indices and significant clinical risk factors as features were developed and their diagnostic accuracy metrics were evaluated.
Results:
SpO2 measures significantly differed between groups by PH status. The model with signal-based measures and clinical features of birthweight, sepsis, and presence of patent ductus arteriosus had discriminative ability for PH with 82% area under ROC (95% CI: 75%, 88%) and accuracy, sensitivity, and specificity of 81%, 78% and 82% respectively.
Conclusion:
Irregularity profiles of oxygen saturation variability are distinct in infants with BPD and PH. Signal based measures derived from routinely collected SpO2 data can be leveraged as continuous bedside markers to detect PH in preterm infants.
Impact:
Early detection of pulmonary hypertension (PH) may improve outcomes in infants with bronchopulmonary dysplasia (BPD). Bedside markers which can track evolving PH, using routinely collected data in the NICU are hence important. Analysis of the irregularity exhibited by oxygen saturation variability data from preterm infants with BPD identified distinctive behavior in the presence of PH. We demonstrated detection of PH using signal measures accounting for known clinical risk factors using data acquired prior to clinical diagnosis. This study expands the possibility of implementing signal based models for early identification of PH in this vulnerable population.
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