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Published on: June 5, 2019
Association of Heart Rate Variability with Postnatal Maturation in Preterm Infants
Siree Kaempfen1, Carlos Sanchez2, Edgar Delgado-Eckert2,3
1Department of Neonatology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland.
Insights
Sample entropy (SampEn) of heart rate time series reflects postnatal maturation in preterm infants, increasing with age and approaching term infant levels by discharge. However, it has limited predictive value for discharge timing.
Area of Science:
- Neonatal Physiology
- Cardiovascular Monitoring
- Biomedical Signal Processing
Background:
- Assessing postnatal maturation in preterm infants is crucial for predicting developmental trajectories.
- Heart rate variability analysis, specifically sample entropy (SampEn), offers a non-invasive method to evaluate autonomic nervous system function.
- Understanding SampEn's role in preterm infant development can inform clinical management and prognostication.
Purpose of the Study:
- To determine if longitudinal SampEn measurements reflect postnatal maturation in preterm infants.
- To evaluate SampEn's predictive value for hospital discharge timing at 32 weeks of postmenstrual age (PMA).
- To compare SampEn in preterm infants at discharge with that of term-born infants.
Main Methods:
- A prospective study included preterm infants (<32 weeks gestation) and term infant controls.
- Heart rate was continuously monitored, and SampEn was calculated from 90-minute recordings.
- Assessments were conducted at 32 and 36 weeks PMA for preterm infants and during the first month of life for term infants.
Main Results:
- SampEn increased significantly in preterm infants from 32 to 36 weeks PMA (0.35 to 0.40; p < 0.01).
- SampEn correlated positively with maturation and growth, and negatively with prematurity complications like bronchopulmonary dysplasia.
- SampEn at 32 weeks PMA did not improve discharge prediction, and discharge SampEn did not differ between preterm and term infants.
Conclusions:
- SampEn of heart rate time series increases with postnatal maturation in preterm infants.
- Preterm infants reach term-like SampEn values by the time of hospital discharge.
- While associated with complications, SampEn's prognostic value for discharge timing is limited.
Abstract:
Introduction: We assessed whether longitudinal measurements of sample entropy (SampEn) of heart rate time series reflect postnatal maturation in preterm infants and evaluated its predictive value at 32 weeks of postmenstrual age (PMA) for estimating discharge home. We further compared SampEn of preterm infants at discharge with that of term infants.
Methods:
We conducted a prospective study at the University Children's Hospital Basel, Switzerland, from 2018 to 2022. We included preterm infants born before 32 weeks of gestation and a control group of term infants. Heart rate was recorded using the clinical monitoring system. We assessed preterm infants at 32 and 36 weeks of PMA, and at discharge, term infants were evaluated between 3 and 28 days of life. SampEn was calculated from 90-min recordings using custom analytical software.
Results:
We obtained valid data from 183/183 preterm infants (mean [range] 28.4 [23.3-31.7] weeks of gestation) and from 80/104 (76%) term infants. In preterm infants, SampEn increased from 32 to 36 weeks of PMA (0.35 vs. 0.40; p < 0.01) without further increase to discharge. SampEn was positively associated with maturation and growth, and negatively with complications of prematurity, particularly with bronchopulmonary dysplasia. SampEn at 32 weeks of PMA did not improve clinical predictions of PMA at discharge. At discharge, SampEn did not differ significantly between preterm and term infants.
Conclusion:
SampEn of heart rate time series increased with postnatal maturation in preterm infants, reaching values of term infants at discharge. It was negatively associated with complications of prematurity but its prognostic value for discharge timing is limited.
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