Abstract
This study aims at investigating the development of premature infants' autonomic nervous system (ANS) based on a quantitative analysis of the heart-rate variability (HRV) with a variety of novel features. Additionally, the role of heart-rate drops, known as bradycardias, has been studied in relation to both clinical and novel sympathovagal indices. ECG data were measured for at least 3 h in 25 preterm infants (gestational age ≤32 weeks) for a total number of 74 recordings. The post-menstrual age (PMA) of each patient was estimated from the RR interval time-series by means of multivariate linear-mixed effects regression. The tachograms were segmented based on bradycardias in periods after, between and during bradycardias. For each of those epochs, a set of temporal, spectral and fractal indices were included in the regression model. The best performing model has R2 = 0.75 and mean absolute error MAE = 1.56 weeks. Three main novelties can be reported. First, the obtained maturation models based on HRV have comparable performance to other development models. Second, the selected features for age estimation show a predominance of power and fractal features in the very-low- and low-frequency bands in explaining the infants' sympathovagal development from 27 PMA weeks until 40 PMA weeks. Third, bradycardias might disrupt the relationship between common temporal indices of the tachogram and the age of the infant and the interpretation of sympathovagal indices. This approach might provide a novel overview of post-natal autonomic maturation and an alternative development index to other electrophysiological data analysis.
Highlights
Premature infants represent 10% of the neonatal population and are at higher risk for developmental disorders that can lead to adverse outcome (Aylward, 2014)
The overview shows that the infants have an average post-menstrual age (PMA) of weeks and recordings are collected in the range
This study provides an overview of the autonomic nervous system maturation in preterm infants and aims to estimate the post-menstrual age of the infants based on the Heart-rate variability (HRV)
Summary
Premature infants represent 10% of the neonatal population and are at higher risk for developmental disorders that can lead to adverse outcome (Aylward, 2014). A common probe to inspect the development of the neurovegetative functions or Autonomic Nervous System (ANS) is the heart-rate fluctuation, known as Heart-rate variability (HRV). The guidelines of the adult HRV task force clearly specify the association between the different frequency tones of the tachograms and the stimulation of the ANS branches (Camm et al, 1996). The stimulation of the sympathetic branch is normally represented by the low-frequency band 0.15] Hz) of the HRV, while the high-frequency band The sympathovagal balance can be expressed by the power ratio of the two frequency bands
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