Document Detail

Breath-by-breath analysis of cardiorespiratory interaction for quantifying developmental maturity in premature infants.
MedLine Citation:
PMID:  22174403     Owner:  NLM     Status:  MEDLINE    
In healthy neonates, connections between the heart and lungs through brain stem chemosensory pathways and the autonomic nervous system result in cardiorespiratory synchronization. This interdependence between cardiac and respiratory dynamics can be difficult to measure because of intermittent signal quality in intensive care settings and variability of heart and breathing rates. We employed a phase-based measure suggested by Schäfer and coworkers (Schäfer C, Rosenblum MG, Kurths J, Abel HH. Nature 392: 239-240, 1998) to obtain a breath-by-breath analysis of cardiorespiratory interaction. This measure of cardiorespiratory interaction does not distinguish between cardiac control of respiration associated with cardioventilatory coupling and respiratory influences on the heart rate associated with respiratory sinus arrhythmia. We calculated, in sliding 4-min windows, the probability density of heartbeats as a function of the concurrent phase of the respiratory cycle. Probability density functions whose Shannon entropy had a <0.1% chance of occurring from random numbers were classified as exhibiting interaction. In this way, we analyzed 18 infant-years of data from 1,202 patients in the Neonatal Intensive Care Unit at University of Virginia. We found evidence of interaction in 3.3 patient-years of data (18%). Cardiorespiratory interaction increased several-fold with postnatal development, but, surprisingly, the rate of increase was not affected by gestational age at birth. We find evidence for moderate correspondence between this measure of cardiorespiratory interaction and cardioventilatory coupling and no evidence for respiratory sinus arrhythmia, leading to the need for further investigation of the underlying mechanism. Such continuous measures of physiological interaction may serve to gauge developmental maturity in neonatal intensive care patients and prove useful in decisions about incipient illness and about hospital discharge.
Matthew T Clark; Craig G Rusin; John L Hudson; Hoshik Lee; John B Delos; Lauren E Guin; Brooke D Vergales; Alix Paget-Brown; John Kattwinkel; Douglas E Lake; J Randall Moorman
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2011-12-15
Journal Detail:
Title:  Journal of applied physiology (Bethesda, Md. : 1985)     Volume:  112     ISSN:  1522-1601     ISO Abbreviation:  J. Appl. Physiol.     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-03-02     Completed Date:  2012-09-11     Revised Date:  2013-09-26    
Medline Journal Info:
Nlm Unique ID:  8502536     Medline TA:  J Appl Physiol (1985)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  859-67     Citation Subset:  IM    
Department of Chemical Engineering, University of Virginia, Charlottesville, USA.
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MeSH Terms
Autonomic Nervous System / physiology
Birth Weight / physiology
Breath Tests / methods
Gestational Age
Heart / physiology*
Heart Rate / physiology
Infant, Newborn
Infant, Premature / growth & development,  physiology*
Intensive Care Units, Neonatal
Lung / physiology*
Respiratory Mechanics / physiology*
Grant Support
1 1RC2 HD-064488-02/HD/NICHD NIH HHS

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