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Continuous monitoring of heart rate variability in preterm infants
V Prietsch1, U Knoepke, M Obladen
1Children's Hospital, Philipps-Universität Marburg, Germany.
Insights
This study presents a new method for continuous neonatal monitoring of heart rate variability (HRV) and other vital signs in the NICU. Findings show HRV increases with age but decreases with respiratory distress syndrome and impaired brain function.
Area of Science:
- Neonatal physiology
- Intensive care medicine
- Biomedical engineering
Background:
- Continuous monitoring of physiological parameters is crucial for neonatal intensive care.
- Heart rate variability (HRV) is a sensitive indicator of autonomic nervous system function in neonates.
- Existing monitoring methods may have limitations in capturing dynamic changes in neonatal physiology.
Purpose of the Study:
- To develop and evaluate a method for continuous monitoring and recording of neonatal heart rate variability (HRV) and other physiological parameters.
- To assess the influence of gestational age, postnatal age, respiratory distress syndrome (RDS), and brain function on neonatal HRV.
- To establish a reliable system for data acquisition and analysis in the neonatal intensive care unit (NICU).
Main Methods:
- A system was developed connecting 16 neonatal monitors to a personal computer via I/O processor boards.
- Specialized software processed patient data, enabling continuous 24-hour recording of HRV (long-term and short-term variability), heart rate, respiratory rate, body temperature, incubator temperature, tcPO2, and tcPCO2.
- Automatic artifact removal was implemented for all parameters, with daily computation of median and percentiles from valid values.
Main Results:
- Continuous monitoring successfully captured long-term (LTV) and short-term variability (STV) of heart rate along with other physiological parameters.
- Both LTV and STV showed an increase with advancing gestational and postnatal age in preterm infants.
- Infants with respiratory distress syndrome (RDS) exhibited decreased LTV, correlated with disease severity. Impaired brain function (due to intraventricular hemorrhage, asphyxia, or sedation) was also associated with decreased HRV.
Conclusions:
- The developed method provides continuous, detailed physiological monitoring for neonates in the ICU.
- Neonatal HRV is significantly influenced by developmental factors (gestational and postnatal age) and clinical conditions like RDS and brain injury.
- This monitoring approach offers valuable insights into neonatal autonomic function and its alterations in critical illness, aiding clinical assessment and management.
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.