Detection of Tachyarrhythmias in a Large Cohort of Infants Using Direct-to-Consumer Heart Rate Monitoring

Anjewierden, Scott; Humpherys, Jeffrey; LaPage, Martin J.; Asaki, S. Yukiko; Aziz, Peter F.

doi:10.1016/j.jpeds.2020.12.080

Cited by 18 publications

(7 citation statements)

References 22 publications

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“…15 The prevalence of tachyarrhythmias was 2.5% in that cohort, which was higher than previously reported. 15 The false positive rate was unknown, but the study highlighted that tachyarrhythmias might occur in a baby at home. Early recognition of tachyarrhythmias with a wireless home monitoring device could be lifesaving.…”

Section: Discussioncontrasting

confidence: 66%

Accuracy of Wireless Pulse Oximeter on Preterm or <2.5 kg Infants

et al. 2023

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Objective Monitoring heart rate (HR) and oxygen saturation (SpO2) in infants is essential in the neonatal intensive care unit. Wireless pulse oximeter technology has been advancing but with limited accuracy data on preterm infants. This observational study compared HR and SpO2 of the wireless Owlet Smart Sock 3 (OSS3) to the wired Masimo SET (Masimo) pulse oximeter in preterm or <2.5 kg infants. Study Design Twenty-eight eligible infants were enrolled. They weighed between 1.7 and 2.5 kg and were without anomalies or medical instability. OSS3 and Masimo simultaneously monitored HR and SpO2 for 60 minutes. The data were aligned by time epoch and filtered for poor tracings. The agreement was compared using the Pearson's correlation coefficient, the Bland–Altman method, average root mean square (ARMS), and prevalence and bias adjusted kappa (PABAK) analyses. Results Two infants' data were excluded due to motion artifacts or device failures. The corrected gestational age and current weights were 35 ± 3 weeks and 2.0 ± 0.2 kg (mean ± standard deviation), respectively. Over 21 hours of data showed that HR was strongly correlated between the two devices (r = 0.98, p < 0.001), with a difference of −1.3 beats per minute (bpm) and the limit of agreement (LOA) −6.3 to 3.4 bpm based on the Bland–Altman method. SpO2 was positively correlated between the two devices (r = 0.71, p < 0.001) with a SpO2 bias of 0.3% (LOA: −4.6 to 4.5%). The estimated ARMS of OSS3 compared with Masimo was 2.3% for SpO2 in the 70 to 100% range. The precision decreased with lower SpO2. A strong agreement (PABAK = 0.94) was between the two devices on whether SpO2 was above or below 90%. Conclusion OSS3 provided comparable HR and SpO2 accuracy to Masimo in preterm or <2.5 kg infants. Motion artifacts, lack of arterial blood gas comparisons, and lack of racial and ethnic diversity are the study limitations. More OSS3 data on the Lower HR and SpO2 ranges were needed before implementing inpatient use. Key Points

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Section: Discussioncontrasting

confidence: 66%

Accuracy of Wireless Pulse Oximeter on Preterm or <2.5 kg Infants

et al. 2023

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“…A recent study evaluating direct-to-consumer home heart rate monitors revealed a 2.5% incidence of tachyarrhythmias (heart rate >240 bpm for >60 seconds) during the first year of life. 44 Although this is a select and possibly higher-risk group, the data suggest a higher incidence of subclinical neonatal and infant tachycardia than previously thought and that such monitors may play a greater role in the detection of these arrhythmias in the future. 44 This is a nascent technology, and further data are needed before criteria for clinical use can be proposed.…”

Section: Arrhythmias In Neonatesmentioning

confidence: 77%

“…44 Although this is a select and possibly higher-risk group, the data suggest a higher incidence of subclinical neonatal and infant tachycardia than previously thought and that such monitors may play a greater role in the detection of these arrhythmias in the future. 44 This is a nascent technology, and further data are needed before criteria for clinical use can be proposed.…”

Section: Arrhythmias In Neonatesmentioning

confidence: 77%

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Pharmacological Management of Cardiac Arrhythmias in the Fetal and Neonatal Periods: A Scientific Statement From the American Heart Association

Batra,

Silka,

Borquez

et al. 2024

Circulation

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Disorders of the cardiac rhythm may occur in both the fetus and neonate. Because of the immature myocardium, the hemodynamic consequences of either bradyarrhythmias or tachyarrhythmias may be far more significant than in mature physiological states. Treatment options are limited in the fetus and neonate because of limited vascular access, patient size, and the significant risk/benefit ratio of any intervention. In addition, exposure of the fetus or neonate to either persistent arrhythmias or antiarrhythmic medications may have yet-to-be-determined long-term developmental consequences. This scientific statement discusses the mechanism of arrhythmias, pharmacological treatment options, and distinct aspects of pharmacokinetics for the fetus and neonate. From the available current data, subjects of apparent consistency/consensus are presented, as well as future directions for research in terms of aspects of care for which evidence has not been established.

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“…Moreover, it is possible that SVT recurrences are underestimated in clinical studies due to under-reporting. 38 In addition, antiarrhythmic medication availability is not uniform around the world that influences anti-arrhythmic medication use by institutions. In terms of the systematic review, studies in which a proportion of patients did not meet inclusion criteria (eg, patients with other types of arrhythmia and/or congenital heart disease, or patients older than 1 year of age), and in which data specific to relevant patients could not be isolated, were excluded from statistical analysis.…”

Section: Limitationsmentioning

confidence: 99%