Abstract
BackgroundApnea of prematurity cannot be reliably measured with current monitoring techniques. Instead, indirect parameters such as oxygen desaturation or bradycardia are captured. We propose a Kalman filter-based detection of respiration activity and hence apnea using multichannel esophageal signals in neonatal intensive care unit patients.MethodsWe performed a single-center observational study with moderately preterm infants. Commercially available nasogastric feeding tubes containing multiple electrodes were used to capture signals with customized software. Multichannel esophageal raw signals were manually annotated, processed using extended Kalman filter, and compared with standard monitoring data including chest impedance to measure respiration activity.ResultsOut of a total of 405.4 h captured signals in 13 infants, 100 episodes of drop in oxygen saturation or heart rate were examined. Median (interquartile range) difference in respiratory rate was 0.04 (−2.45 to 1.48)/min between esophageal measurements annotated manually and with Kalman filter and −3.51 (−7.05 to −1.33)/min when compared to standard monitoring, suggesting an underestimation of respiratory rate when using the latter.ConclusionsKalman filter-based estimation of respiratory activity using multichannel esophageal signals is safe and feasible and results in respiratory rate closer to visual annotation than that derived from chest impedance of standard monitoring.
Highlights
IntroductionApnea of prematurity is a well-described condition in preterm infants.[1,2,3] Various apnea definitions exist, commonly referring to a cessation of breathing of at least 15–20 s, potentially being associated with hypoxia and/or bradycardia.[4,5] Subgroups such as central, obstructive, or mixed apnea are further distinguished.[5,6]Importantly, prolonged apnea episodes leading to considerable oxygen desaturation (
We demonstrated reliable heart rate (HR) detection misplacement or secondary dislocation as well as observation of skin irritation at place of external fixation was noted for all participants
We included a total of 31 measurements of 405.4 h duration performed in 9 infants for further signal analysis after excluding 29 measurements for reasons including transfer of the infant to another hospital (n = 5), transfer to another ward with different standard monitoring system (n = 16), inadequate signal quality or interrupted sampling (n = 2 for NEO; n = 6 for neonatal intensive care unit (NICU))
Summary
Apnea of prematurity is a well-described condition in preterm infants.[1,2,3] Various apnea definitions exist, commonly referring to a cessation of breathing of at least 15–20 s, potentially being associated with hypoxia and/or bradycardia.[4,5] Subgroups such as central, obstructive, or mixed apnea are further distinguished.[5,6]Importantly, prolonged apnea episodes leading to considerable oxygen desaturation (
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