Abstract
Early life stress in the neonatal intensive care unit (NICU) can predispose premature infants to adverse health outcomes and neurodevelopment delays. Hands-on-care and procedural pain might induce apneas, hypoxic events, and sleep-wake disturbances, which can ultimately impact maturation, but a data-driven method based on physiological fingerprints to quantify early-life stress does not exist. This study aims to provide an automatic stress detector by investigating the relationship between bradycardias, hypoxic events and perinatal stress in NICU patients. EEG, ECG, and SpO2 were recorded from 136 patients for at least 3 h in three different monitoring groups. In these subjects, the stress burden was assessed using the Leuven Pain Scale. Different subspace linear discriminant analysis models were designed to detect the presence or the absence of stress based on information in each bradycardic spell. The classification shows an area under the curve in the range [0.80–0.96] and a kappa score in the range [0.41–0.80]. The results suggest that stress seems to increase SpO2 desaturations and EEG regularity as well as the interaction between the cardiovascular and neurological system. It might be possible that stress load enhances the reaction to respiratory abnormalities, which could ultimately impact the neurological and behavioral development.
Highlights
Premature infants are at risk of maladaptive outcomes and neurodevelopment delays
The results suggest a moderate association between the bradycardia features and the clinical labels: the area under the curve (AUC) lies in the range [0.80–0.96] and the kappa score lies in the range [0.41–0.80]
The current study investigated the relationship between stress experience and bradycardias in preterm infants by means of physiological data
Summary
Premature infants are at risk of maladaptive outcomes and neurodevelopment delays. Patients who spend their early life in the neonatal intensive care unit (NICU) can undergo profound alterations of sleep-patterns as well as exposure to painful procedures and noxious stimuli (Grunau, 2013; Barbeau and Weiss, 2017). Grunau (2013) have shown how stress exposure can induce a cascade of physiological consequences, behavioral and hormonal responses. Routine day-care has been reported to affect sleep quality inside the NICU (Barbeau and Weiss, 2017). Levy has shown that prolonged contact in NICU can have multiple consequences.
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