Assessment of neonatal respiratory rate variability

Abstract

Accurate measurement of respiratory rate (RR) in neonates is challenging due to high neonatal RR variability (RRV). There is growing evidence that RRV measurement could inform and guide neonatal care. We sought to quantify neonatal RRV during a clinical study in which we compared multiparameter continuous physiological monitoring (MCPM) devices. Measurements of capnography-recorded exhaled carbon dioxide across 60-s epochs were collected from neonates admitted to the neonatal unit at Aga Khan University-Nairobi hospital. Breaths were manually counted from capnograms and using an automated signal detection algorithm which also calculated mean and median RR for each epoch. Outcome measures were between- and within-neonate RRV, between- and within-epoch RRV, and 95% limits of agreement, bias, and root-mean-square deviation. Twenty-seven neonates were included, with 130 epochs analysed. Mean manual breath count (MBC) was 48 breaths per minute. Median RRV ranged from 11.5% (interquartile range (IQR) 6.8–18.9%) to 28.1% (IQR 23.5–36.7%). Bias and limits of agreement for MBC vs algorithm-derived breath count, MBC vs algorithm-derived median breath rate, MBC vs algorithm-derived mean breath rate were − 0.5 (− 2.7, 1.66), − 3.16 (− 12.12, 5.8), and − 3.99 (− 11.3, 3.32), respectively. The marked RRV highlights the challenge of performing accurate RR measurements in neonates. More research is required to optimize the use of RRV to improve care. When evaluating MCPM devices, accuracy thresholds should be less stringent in newborns due to increased RRV. Lastly, median RR, which discounts the impact of extreme outliers, may be more reflective of the underlying physiological control of breathing.

Counting: an imprecise reference standard for respiratory rate measurement

“…When measuring RR, if the intent is to measure the underlying physiology that is triggering each breath, measuring a breath interval is likely to be more precise than counting breaths. 4 Given that the RRate app's average number of taps to measure RR in the study was 6, at a median RR of 55, the RRate measured the RR in 6.5 seconds, and would not be equivalent to a RR measured over 30 or 60 seconds, especially in infants in whom RR variability is much higher at faster RRs. 5 To facilitate a more accurate comparison of the two RR apps and a more precise estimate of the repeatability of breath count observations, the authors could consider measuring the breath intervals by identifying a specific video frame in the video recordings used in the study for each breath.…”

Respiratory Rate Extraction from Neonatal Near-Infrared Spectroscopy Signals

“…Respiratory events and associated desaturation events affect cerebral physiology and contain relevant information about cerebral hemodynamics [7][8][9][10]. Hence, continuous monitoring of RR changes in hospitalized neonates and the impact on cerebral hemodynamics is of importance in clinical practice [11][12][13].…”

Non-contact respiratory rate monitoring using thermal and visible imaging: a pilot study on neonates

“…Studies have shown that there is an increment in the number of neonatal admission due to respiratory distress [4]. Detection and assessment of respiratory dysfunction at an early stage enable appropriate medical treatment, and respiratory monitoring saves the lives of newborns [5].…”