Neonatal Heart Rate Research Articles

Fetomaternal Outcome in Severe Preeclamptic Women Undergoing Emergency Cesarean Section with Spinal or General Anesthesia

Background: Preeclampsia (PE) is a hypertensive disease specific to pregnancy and it complicates 5–10 % of all pregnancies and it is a major cause of maternal, fetal, and neonatal morbidity and mortality worldwide. Preeclampsia is defined as new-onset hypertension (systolic blood pressure 140 mm Hg or diastolic blood pressure 90 mm Hg) and new-onset proteinuria after 20 weeks of gestation in previously normotensive patients. Objective: The aim of this work is to show the fetomaternal outcome of severe preeclampsia in women undergoing emergency cesarean section with either spinal or general anesthesia. Which better? Patients and Methods: This study was conducted at El Sayed Galal and El Hussein University Hospitals. 180 pregnant women with severe preeclampsia admitted to the operating room for emergency cesarean section were included and divided into 2 groups: Group I: 150 patients underwent cesarean section under spinal anesthesia. Group II: 30 patients underwent cesarean section under general anesthesia. This study was prospective observational study. The patients fulfilled our inclusion criteria and signed a well informed consent to declare their agreement to be in this study as agreed upon by the ethical committee. Results: The mean values of DBP were significantly higher in group II than in group I (p <0.05). The incidence of maternal complications was significantly higher in group II more than group I, especially in vomiting, high blood pressure and convulsion (p <0.05). There was a significant increase in neonatal weight in group I more than group II (p <0.05). Regarding preterm, there was a significant increase in preterm cases in group II (60%) more than group I (38%) (p <0.05). Regarding APGAR score at 1 and 5 min, it was found that there was a significant increase in APGAR score in group I more than group II at both 1 minute and 5 minutes (p <0.05). The mean values of neonatal heart rate were significantly higher in group II than in group I (p <0.05). The mean values of neonatal respiratory rate were significantly higher in group I than in group II (p <0.05). Regarding breast feeding after cesarean section (hrs.), there was a significant increase in the duration after cesarean section till the breast feeding in group II more than group I (p < 0.05). Regarding neonatal mortality, there was a significant increase in mortality in group II (16.7%) more than group I (2.7%), (p <0.05). Conclusion: This means that spinal anesthesia is a safer alternative to general anesthesia in severe preeclampsia with less postoperative morbidity and mortality regarding both mothers and babies. These findings agreed with many previous studies worldwide.

Fetomaternal Outcome in Severe Preeclamptic Women Undergoing Emergency Cesarean Section with Spinal or General Anesthesia

Background: Preeclampsia (PE) is a hypertensive disease specific to pregnancy and it complicates 5–10 % of all pregnancies and it is a major cause of maternal, fetal, and neonatal morbidity and mortality worldwide. Preeclampsia is defined as new-onset hypertension (systolic blood pressure 140 mm Hg or diastolic blood pressure 90 mm Hg) and new-onset proteinuria after 20 weeks of gestation in previously normotensive patients. Objective: The aim of this work is to show the fetomaternal outcome of severe preeclampsia in women undergoing emergency cesarean section with either spinal or general anesthesia. Which better? Patients and Methods: This study was conducted at El Sayed Galal and El Hussein University Hospitals. 180 pregnant women with severe preeclampsia admitted to the operating room for emergency cesarean section were included and divided into 2 groups: Group I: 150 patients underwent cesarean section under spinal anesthesia. Group II: 30 patients underwent cesarean section under general anesthesia. This study was prospective observational study. The patients fulfilled our inclusion criteria and signed a well informed consent to declare their agreement to be in this study as agreed upon by the ethical committee. Results: The mean values of DBP were significantly higher in group II than in group I (p <0.05). The incidence of maternal complications was significantly higher in group II more than group I, especially in vomiting, high blood pressure and convulsion (p <0.05). There was a significant increase in neonatal weight in group I more than group II (p <0.05). Regarding preterm, there was a significant increase in preterm cases in group II (60%) more than group I (38%) (p <0.05). Regarding APGAR score at 1 and 5 min, it was found that there was a significant increase in APGAR score in group I more than group II at both 1 minute and 5 minutes (p <0.05). The mean values of neonatal heart rate were significantly higher in group II than in group I (p <0.05). The mean values of neonatal respiratory rate were significantly higher in group I than in group II (p <0.05). Regarding breast feeding after cesarean section (hrs.), there was a significant increase in the duration after cesarean section till the breast feeding in group II more than group I (p < 0.05). Regarding neonatal mortality, there was a significant increase in mortality in group II (16.7%) more than group I (2.7%), (p <0.05). Conclusion: This means that spinal anesthesia is a safer alternative to general anesthesia in severe preeclampsia with less postoperative morbidity and mortality regarding both mothers and babies. These findings agreed with many previous studies worldwide.

ASSESSMENT OF HEART RATE USING AUSCULTATION AND ELECTROCARDIOGRAPHY DURING NEONATAL RESUSCITATION IN A PORCINE MODEL OF ASPHYXIA

Abstract BACKGROUND Recent neonatal resuscitation guidelines have suggested the potential benefit of introducing Electrocardiography (ECG) to monitor neonatal heart rate (HR) as standard of care for newborns receiving respiratory support in the delivery room due to advantages over auscultation. OBJECTIVES To assess effectiveness of HR detection using either ECG or auscultation. DESIGN/METHODS We reviewed recordings from our piglet neonatal resuscitations to compare an ECG with auscultation for assessing the detection of HR at cardiac arrest. Term newborn piglets (n=41) were anesthetized, intubated, instrumented, and exposed to 40-min normocapnic hypoxia followed by asphyxia, which was achieved by clamping the endotracheal tube until asystole. Asystole was confirmed by using Electrocardiography and auscultation. RESULTS The median (±IQR) duration of asphyxia was 318 (200–560)sec. In 41 piglets both auscultation and ECG HR were assessed. In 11 (27%) cases both auscultation and ECG correctly identified a bradycardic HR (mean (SD) 32(14)/min) at the beginning of chest compression. In 11 (27%) cases both auscultation and ECG correctly identified absent of any HR. However, in 19 (46%) cases auscultation did not detect a HR while ECG did detect a HR. Overall, the Positive Predictive Value was 37%, Negative Predictive Value was 100%, Sensitivity was 100%, and Specificity was 37% for the ECG to display accurate HR during asphyxia in newborn piglets. CONCLUSION Our data illustrates the need for caution in the routine use of ECG monitoring for all neonatal who might need advanced resuscitation in the deliver room.

Accurate and fast neonatal heart rate assessment with a smartphone-based application - a manikin study.

AimThis study determined the accuracy and speed of the NeoTapLifeSupport (NeoTapLS), a free smartphone application that aims to assess a neonate's heart rate.MethodsWe asked 30 participants with a variety of backgrounds to test the NeoTapLS, which was developed by our own nonprofit organisation Tap4Life, to determine a randomly selected heart rate by auscultation or palpation. The study was carried out in 2014 at Sachs’ Children and Youth Hospital, Sweden, using a Laerdal SimNewB manikin that simulates true values. The NeoTapLS calculates the heart rate based on the user's last three taps on the smartphone screen.ResultsA total of 1200 measurements were carried out. A high correlation was found between measured and true values by auscultation (correlation coefficient 0.993) as well as by palpation (correlation coefficient 0.986) with 93.5% of the auscultations and 86.3% of the palpations differing from the true value by five beats or fewer. The mean time to the first estimated heart rate was 14.9 seconds for auscultation and 16.3 seconds for palpation.ConclusionHeart rates could be accurately and rapidly assessed using the NeoTapLS on a manikin. A globally accessible mobile health system could offer a low‐cost alternative to expensive medical equipment.

Synchronized Oscillations of Arterial Oxygen Saturation, Cerebral Tissue Oxygenation and Heart Rate in Preterm Neonates: Investigation of Long-Term Measurements with Multiple Einstein's Cross Wavelet Analysis.

In preterm neonates, the cardiovascular and cerebral vascular control is immature, making the brain vulnerable to an increased incidence of hypoxic and hyperoxic episodes. The aim of the study was to apply the recently developed multiple Einstein's cross wavelet analysis (MECWA) to quantify the coupling of fluctuations of peripherally measured arterial oxygen saturation (SpO2), cerebral tissue oxygen saturation (StO2) and heart rate (HR). Two long-term measurements on preterm neonates with a gestational age at birth of 26.4 and 26.8weeks and a postnatal age of 2.1 and 3.9weeks were analyzed. MECWA was applied to SpO2, StO2 and HR. MECWA showed that the fluctuations of SpO2, StO2 and HR were synchronized in the low-frequency range with periods of ~1h and ~0.5h. The amplitudes of the synchronization frequencies were dependent on the individual neonate. MECWA is a useful novel tool to assess the coupling of physiological signals. The parameters determined by MECWA seem to be related to the chronobiological processes, as well as constant regulations of the cardiovascular and cerebral perfusion state. MECWA was able to identify long-term synchronization of the cardiovascular and cerebral perfusion state in preterm neonates with periods of ~1h and ~0.5h.

Neonatal effects after vasopressor during spinal anesthesia for cesarean section: a multicenter, randomized controlled trial

BackgroundPlacental transfer of ephedrine causes fetal effects when compared with phenylephrine. This study compared their drug effects on neonatal parameters after cesarean delivery under spinal anesthesia. MethodsThree-hundred-and-fifty-four women undergoing elective cesarean delivery who needed intravenous vasopressor following spinal anesthesia were randomized into two groups. Group E received boluses of ephedrine 6mg, and Group P phenylephrine 100µg, titrated to maintain systolic blood pressure near baseline values. Neonatal heart rates at 10 and 30–45min of age, oxygen saturation and capillary blood glucose at 30min, and capillary blood lactate and urine metamphetamine were recorded. ResultsNeonatal heart rate at 10min was significantly higher (mean difference 4.0, 95%CI 0.6 to 7.3, P=0.02) in Group E versus Group P, but this was not clinically relevant. There was a linear correlation between neonatal heart rate at 10min and ephedrine dose in Group E (r2=0.29, 95%CI 0.22, 0.74, p<0.01). The decremental changes in neonatal heart rate at 10 and 30min were significantly greater in Group E. Urine metamphetamine tests were positive in 19% of 44 neonatal urine samples. Neonatal heart rates at 30min, oxygen saturation, capillary blood glucose and the incidence of tachycardia, respiratory problems or abnormal glucose, were not significantly different. ConclusionsEphedrine, compared to phenylephrine as a vasopressor during cesarean delivery, was associated with higher neonatal heart rate in the early post-birth period, but without a significant difference in clinical outcomes in uncomplicated pregnancies.

MP24: Effect on pain of an oral sucrose solution versus placebo in children 1 to 3 months old needing nasopharyngeal aspiration; a randomized controlled trial

Introduction: Oral sweet solutions have been accepted as effective pain reducing agents for neonates. However studies in the Emergency Department (ED) setting have conflicting results. The objective is to compare the efficacy of an oral sucrose solution versus placebo in reducing pain in children 1 to 3 months of age during nasopharyngeal aspiration (NPA) in the ED. Methods: A randomized, double-blinded, placebo controlled clinical trial was conducted in a pediatric university-affiliated hospital ED. Participants from 1 to 3 months of age requiring NPA were recruited and randomly allocated to receive 2 mls of an 88% sucrose solution (SUC) or 2 mls of a placebo solution (PLA) orally, 2 mins before NPA. The primary outcome was the mean difference in pain scores at 1 min post NPA as assessed by the Face, Legs, Activity, Cry and Consolability (FLACC) Pain Scale. Secondary outcomes were the difference in pain scores using the Neonatal Infant Pain Scale (NIPS), crying time, heart rate and adverse events. Results: 72 participants were recruited and completed the study, 37 (group SUC) and 35 (group PLA) respectively. Both groups had similar demographic and clinical characteristics and baseline FLACC and NIPS pain scores (all p=value &amp;gt;0.4). The mean difference in FLACC scores compared to baseline was 3.3 (2.5-4.1) (SUC) vs. 3.2 (2.3-4.1) (PLA) (p=.94) at 1 min and -1.2 (-1.7 to 0.7) (SUC) vs. -0.8 (-1.5 to -0.1) (PLA) (p=.66) at 3 mins after NPA. For the NIPS scores, it was 2.3 (1.6-3.0) (SUC) vs. 2.5 (1.8-3.2) (PLA) (p=.86) at 1 min and -1.2 (-1.6 to -0.8) (SUC) vs. -0.8 (-1.3 to 0.2) (PLA) (p=.59) 3 mins after NPA. There was no difference in the mean crying time, 114 (98-130) secs (SUC) vs. 109 (92-126) secs (PLA) (p=.81). No significant difference was found in participants’ heart rate at 1 min 174 (154-194) BPM (SUC) vs. 179 (160-198) BPM (PLA) (p=.32) and at 3 mins 165 (143-187) BPM (SUC) vs. 164 (142-186) BPM (PLA) (p=.86) after NPA. Three patients had vomiting during the procedure (2 PLA and 1 SUC), and one had an episode of chocking (PLA). Conclusion: In infants 1 to 3 months of age undergoing nasopharyngeal aspiration in the ED, administration of an oral sweet solution did not statistically decrease pain scores as measured by the FLACC and NIPS scales. Participants’ heart rate and crying time were not significantly decreased when sucrose was provided.

Pengaruh 4SS (Swaddling, Side, Shushing, Swinging) terhadap Heart Rate Neonatus Paska pengambilan Darah Vena di Ruang Edelweis RSUD Ngudi Waluyo Wlingi

Neonates experience changes in all the systems one of the most dramatic changes is the cardiovascular system. Neonates born in hospitals Wlingi all venous blood should be taken where the effect of this action is definitely cause discomfort which can affect the heart rate of neonates. Techniques that can improve the comfort of one of them with techniques 4Ss (swaddling, side, shush- ing, swinging) The purpose of this study was to determine the effect on heart rate 4Ss post neonatal venous blood sampling.This research design using posttest only control group. The research was conducted at room Edelweiss Ngudi Waluyo Hospital Wlingi for 1 month (5-29 November 2014). Subjects were neonates who meet the inclusion criteria. The total sample of 34 neonates in the two groups of 17 treatment group and 17 control group. Sampling using accidental sampling technique. The collection of data through observation in the treatment group and the control group. Data were analyzed by T-test.The results showed heart rate is lower in the treatment group compare the con- trol group. The results of the statistical test showed P-valiu = 0.001 which means that there is an influence on heart rate 4Ss post neonatal venous blood sampling.It is hoped with this study 4Ss technique can be applied by health workers and parents to provide comfort in neonates.

Effect of recorded male lullaby on physiologic response of neonates in NICU

PurposeMost infants in the NICU are exposed to sensory overloads and deprivations as part of their care. This study conducted to assess the effect of lullaby on physiologic response of neonates admitted to NICU. MethodThis is a randomized double-blind intervention trial which was performed on 52 neonates in Jahrom (Iran) 2013–2014. The samples were randomly assigned into lullaby group and a control group (sampling was sequential and randomization was by lottery). Neonates in lullaby group (n=26) listened to male lullaby via headphones during 3days and daily for 20min. Headphones without sound were placed for the control group (n=26) during this period. Immediately before the intervention, 10min later, 20min after the start and 20min after the completion of it, changes in heart rate and oxygen saturation were recorded by heart monitor, then data were analyzed by software SPSS:V 21, Greenhouse-Geisser test, repeated measures and t-test. ResultsThe mean of Heart rate in secondday at 20th and 40th minutes in lullaby group were less than control and this differences were significant (respectively p=0.013, 0.026).Also the blood oxygen saturation levels on the first day at 20th minutes, secondday at 10th minutes–20th and 40th minutes and the third on 40min were significantly different among groups. ConclusionLullaby (male voice and without music) could significantly reduce heart rate and increase blood oxygen saturation of neonates. Future studies are required to make music as a part of evidence-based strategies to promote outcome of neonates in NICUs.

Design of smart neonatal health monitoring system using SMCC.

Automated health monitoring and alert system development is a demanding research area today. Most of the currently available monitoring and controlling medical devices are wired which limits freeness of working environment. Wireless sensor network (WSN) is a better alternative in such an environment. Neonatal intensive care unit is used to take care of sick and premature neonates. Hypothermia is an independent risk factor for neonatal mortality and morbidity. To prevent it an automated monitoring system is required. In this Letter, an automated neonatal health monitoring system is designed using sensor mobile cloud computing (SMCC). SMCC is based on WSN and MCC. In the authors' system temperature sensor, acceleration sensor and heart rate measurement sensor are used to monitor body temperature, acceleration due to body movement and heart rate of neonates. The sensor data are stored inside the cloud. The health person continuously monitors and accesses these data through the mobile device using an Android Application for neonatal monitoring. When an abnormal situation arises, an alert is generated in the mobile device of the health person. By alerting health professional using such an automated system, early care is provided to the affected babies and the probability of recovery is increased.

Comparative Effect of the Smells of Amniotic Fluid, Breast Milk, and Lavender on Newborns' Pain During Heel Lance.

The aim of this randomized controlled experimental study was to evaluate the effect of the smells of amniotic fluid, breast milk, and lavender on the pain of newborns during heel lance. The sample of the study consisted of 102 newborn infants who complied with the sampling criteria between August and November, 2011. The newborns smelled the samples (lavender, breast milk, amniotic fluid, and distilled water) for 5 minutes before the heel lance until 5 minutes afterward. The Neonatal Infant Pain Scale (NIPS), heart rate, and oxygen saturation were evaluated 1 minute before, during, and 1 minute after the heel lance. Data were evaluated by descriptive statistics, chi-square, intraclass correlation analysis, Spearman's rho correlation, Bonferroni's advanced analysis, Shapiro-Wilk, Kruskal-Wallis, Mann-Whitney U, Friedman, and Dunnett's tests. The newborns in the control group had severe pain and the newborns in the breast milk, amniotic fluid, and lavender groups had moderate pain during the heel lance (p < 0.05). While the NIPS score of the newborns in the lavender group was lower than the breast milk and amniotic fluid groups during the heel lance, it was lower in the breast milk and amniotic fluid groups than the lavender group afterward. The lowest falls in oxygen saturation and increased in heart rate were in the breast milk and lavender groups during heel the lance. The smells of lavender and breast milk prevent the increased heart rates, NIPS, falling oxygen saturation, and reduced pain during the invasive procedures in newborns more than amniotic fluid or control group.

Measurement of neonatal heart rate using handheld Doppler ultrasound

ObjectiveThis pilot study aimed to determine whether handheld Doppler ultrasound is feasible and reliable for measuring neonatal heart rate (HR) when compared with ECG.SettingStable newborns were recruited from the neonatal...

Heart rate variability in neonates of type 1 diabetic pregnancy

BackgroundCardiomyopathy is a common finding in offspring of pre-gestational type 1 diabetic pregnancy. Echocardiographic and biochemical evidence of fetal cardiac dysfunction have also been reported. Studies suggest that offspring of diabetic mothers (ODM) undergo a fetal programming effect due to the hyperglycaemic intrauterine milieu which increases their risk of cardiovascular morbidity in adult life. Decreased neonatal heart rate variability (HRV) has been described in association with in-utero growth restriction, prematurity, sudden infant death syndrome and congenital heart disease. The effect of in-utero exposure to hyperglycaemia in diabetic pregnancy on neonatal HRV is unknown. AimsOur aim was to determine if neonatal HRV differs between normal and diabetic pregnancy. Study design and subjectsThis was a prospective observational study of 38 patients with pregestational type 1 diabetes and 26 controls. HRV assessment was performed using Powerlab (ADI Instruments Ltd). Outcome measuresHeart rate variability assessment and cord blood sampling for pH and glucose were performed for all neonates. Maternal glycaemic control was assessed via measurement of glycosylated haemoglobin in each trimester in the diabetic cohort. ResultsNeonates of diabetic mothers had evidence of altered heart rate variability, with increased low frequency to high frequency ratio (LF: HF), suggestive of a shift towards sympathetic predominance (p<0.05). This altered HRV was significantly related to fetal acidaemia, cord blood glucose values and maternal glycaemic control during pregnancy (p<0.05). ConclusionNeonates of pregestational diabetic pregnancy have altered HRV which is related to maternal hyperglycaemia, fetal acidaemia and fetal glycaemia. Exposure of the developing heart to fluctuations in maternal glycaemia with subsequent alterations in HRV may explain why infants of diabetic mothers are at greater risk of cardiovascular disease in later life.

Effects of Breast Milk and Vanilla Odors on Premature Neonate's Heart Rate and Blood Oxygen Saturation During and After Venipuncture

Different studies have shown that the use of olfactory stimuli during painful medical procedures reduces infants' response to pain. The main purpose of the current study was to investigate the effect of breast milk odor and vanilla odor on premature infants' vital signs including heart rate and blood oxygen saturation during and after venipuncture. A total of 135 preterm infants were randomly selected and divided into three groups of control, vanilla odor, and breast milk odor. Infants in the breast milk group and the vanilla group were exposed to breast milk odor and vanilla odor from 5 minutes prior to sampling until 30 seconds after sampling. The results showed that breast milk odor has a significant effect on the changes of neonatal heart rate and blood oxygen saturation during and after venipuncture and decreased the variability of premature infants' heart rate and blood oxygen saturation. Vanilla odor has no significant effect on premature infants' heart rate and blood oxygen saturation. Breast milk odor can decrease the variability of premature infants' heart rate and blood oxygen saturation during and after venipuncture.

Outcome in young patients with isolated complete atrioventricular block and permanent pacemaker treatment: A nationwide study of 127 patients

Subgroups of pacemaker (PM)-treated children with isolated complete atrioventricular block are at risk of developing left ventricular (LV) dysfunction. We aimed to compare the long-term outcome in anti-SSA-Ro/SSB-La antibody-exposed (AB+) and unexposed (AB-) patients and identify preimplantation variables associated with poor outcome. In total, 127 PM-treated patients aged 0-17 years with isolated complete atrioventricular block were studied retrospectively. Sixty-three patients were diagnosed prenatally, of whom 92% were AB+. Before PM treatment, fractional shortening (FS) z-score was significantly lower in AB+ patients than in AB- patients (-0.14 ± 3.6 vs 2.03 ± 2.3). Before PM implantation, there were sex differences (male/female) in median time from diagnosis to PM implantation (0.2 years vs 1.0 years), median neonatal heart rate (50 beats/min vs 60 beats/min), left ventricular end-diastolic dimension (LVEDD) z-score (2.68 ± 1.41 vs 1.74 ± 1.40), and FS (-0.19 ± 3.38 vs 1.42 ± 2.98). The median age at PM implantation was 3.2 years, and median follow-up was 8.7 years. At follow-up, LVEDD and FS did not differ significantly between AB+ and AB- patients, but LVEDD was higher in patients diagnosed before 1 month of age. Nine patients (8%) developed LV dysfunction, and 4 died. LV dysfunction was associated with diagnosis before 1 month of age and abnormal LV function before PM implantation. LV dysfunction at follow-up was seen only in cases diagnosed before 1 month, with abnormal echocardiography before PM implantation. Boys had a more compromised cardiac status and were paced at an earlier age than girls. Fetal AB exposure and male sex were related to abnormal LV function before PM therapy, but not at follow-up.

Effect of skin contact between mother and child in pain relief of full-term newborns during heel blood collection

The aim was to investigate the effect of skin contact between mother and child in pain relief of full-term newborns during heel blood collection.The authors randomly divided 40 full-term newborns into two groups. In the experimental group, the newborn received kangaroo care from the mother before, during, and after the 20-minute heel blood collection. In the control group, the heel blood collection was performed under conventional conditions. The authors compared the two groups' heart rate, oxygen saturation, facial expressions of pain, and duration of crying.The two groups had no statistically significant difference in terms of gender, birth weight, mode of delivery, and gestational age (p > 0.05). In the seven time periods during the puncture after ten seconds from the beginning and ten seconds after the end, the neonatal heart rates of the two groups changed and statistically significant differences were observed in the duration of heel blood collection, interaction and group factors, as well as in oxygen saturation (p < 0.01).During heel blood collection, skin contact between the mother and child can relieve pain, reduce changes in heart rate, improve neonatal heel blood oxygen saturation, and enhance the emotional communication between the mother and child.

Comparing the effect of swaddling and breastfeeding and their combined effect on the pain induced by BCG vaccination in infants referring to Motahari Hospital, Jahrom, 2010–2011

Background and aimDespite the clinical importance of pain, many neonates are subjected to numerous painful invasive procedures and their complications as part of their care. This study has been designed to investigate the effect of swaddling and breastfeeding, and their combined effect on the pain induced by BCG vaccination in healthy term infants. MethodThis randomized double-blind intervention study was performed on 131 healthy term neonates in Motahari Hospital of Jahrom. The samples were randomly assigned into three intervention groups and a control group. The infants in the swaddled group were swaddled 2minutes before and 2minutes after vaccination. The infants in the breastfed group were breastfed within 45minutes before vaccination. The infants in the combination group were both breast fed before and swaddled within vaccination but the infants in the control group were vaccinated without any intervention. Heart rate and oxygen saturation level of neonates were recorded in the 3 phases of: baseline, injection and 2minutes after injection. Furthermore, the neonates' faces were recorded using a video camera. Then pain intensity was measured by Neonatal Facial Coding System (NFCS). Mean Score of pain intensity and physiological responses of subjects were statistically analyzed using non parametrical Kruskal–Wallis test and Mann–Whitney. ResultsThe mean of pain intensity (NFCS) and changes in the heart rate at injection time to the baseline in the three intervention groups in comparison with the control group showed statistically significant difference (p=0.003 and p=0.002 respectively). However changes in blood oxygen saturation level, were not statistically significant difference between four groups. ConclusionRegarding to the significant impact of both breastfeeding and swaddling on the pain reduction of vaccination, it is recommended to take benefit of these two safe and available non-pharmacological methods in order to relief pain during painful procedures.

Third trimester fetal heart rate predicts phenotype and mutation burden in the type 1 long QT syndrome.

Early diagnosis and risk stratification is of clinical importance in the long QT syndrome (LQTS), however, little genotype-specific data are available regarding fetal LQTS. We investigate third trimester fetal heart rate, routinely recorded within public maternal health care, as a possible marker for LQT1 genotype and phenotype. This retrospective study includes 184 fetuses from 2 LQT1 founder populations segregating p.Y111C and p.R518X (74 noncarriers and 110 KCNQ1 mutation carriers, whereof 13 double mutation carriers). Pedigree-based measured genotype analysis revealed significant associations between fetal heart rate, genotype, and phenotype; mean third trimester prelabor fetal heart rates obtained from obstetric records (gestational week 29-41) were lower per added mutation (no mutation, 143±5 beats per minute; single mutation, 134±8 beats per minute; double mutations, 111±6 beats per minute; P<0.0001), and lower in symptomatic versus asymptomatic mutation carriers (122±10 versus 137±9 beats per minute; P<0.0001). Strong correlations between fetal heart rate and neonatal heart rate (r=0.700; P<0.001), and postnatal QTc (r=-0.762; P<0.001) were found. In a multivariable model, fetal genotype explained the majority of variance in fetal heart rate (-10 beats per minute per added mutation; P<1.0×10(-23)). Arrhythmia symptoms and intrauterine β-blocker exposure each predicted -7 beats per minute, P<0.0001. In this study including 184 fetuses from 2 LQT1 founder populations, third trimester fetal heart rate discriminated between fetal genotypes and correlated with severity of postnatal cardiac phenotype. This finding strengthens the role of fetal heart rate in the early detection and risk stratification of LQTS, particularly for fetuses with double mutations, at high risk of early life-threatening arrhythmias.

Time irreversibility of heart rate oscillations in newborns – Does it reflect system nonlinearity?

The aim of our research was to find out if the time irreversibility as a sign of specific class of nonlinear dynamics is present even in the newborn's heart rate oscillations. Multiscale irreversibility indices (Porta's index P%, Guzik index G% and Ehlers index E) of the heart rate signals were computed in 20 healthy neonates. The presence of system nonlinearity was assessed by surrogate data analysis. The results of our analysis revealed asymmetrical nature of heart rate oscillations present in the majority of neonatal heart rate recordings. Moreover, time irreversibility index P% was able to detect shift of sympathovagal balance toward sympathetic dominance in newborns. Our findings support the concept of nonlinearity as a universal feature of the biological control system even in the early stage of the system maturation. This finding supports the application of nonlinear methods to heart rate variability analysis.

A noninvasive heartbeat, respiration, and body movement monitoring system for neonates

Long-term monitoring of heart rate, respiratory rate, and body movement in neonates would be useful for preventing illnesses, such as respiratory disorders. However, currently, there is no noninvasive monitoring system available for neonates. Therefore, in this study, we proposed a modified, noninvasive, piezoceramic-facilitated biometric system to allow measurements of heart rate, respiratory rate, and body movement of neonates. We designed a monitoring system for neonates based on a sensor device with four piezoceramics, which were placed beneath the four legs of a neonatal bed. The output signal from the sensor device was measured as overlaps of the heartbeat, respiration, and body movement components. To test our system, we studied a 7-week-old male preterm infant who was admitted to the neonatal intensive care unit. To determine the validity of our system, electrocardiogram and respiratory waveform output from a conventional bedside monitor were used as references. We observed that the heartbeat signal that was detected by a piezoceramic sensor and that by ECG was similar. Similar findings were also observed between the respiration signal detected by a piezoceramic sensor and the reference respiration signal. In our method, the heartbeat and respiration signals could be accurately measured in the segments in which no body movement was generated. Use of piezoceramics avoids the need for applying sensors to the neonatal body. Our proposed monitoring method would be useful for neonates who require long-term monitoring in the hospital and after discharge, as well as for research purposes.