Stochastic Resonance Effects on Apnea, Bradycardia, and Oxygenation: A Randomized Controlled Trial

Smith, Vincent C.; Kelty-Stephen, Damian G.; Ahmad, Mona Qureshi; Mao, Wenyang; Cakert, Kelly; Osborne, John A.; Paydarfar, David

doi:10.1542/peds.2015-1334

Cited by 29 publications

(38 citation statements)

References 14 publications

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“…In the study of Kattwinkel et al (30), when extremities were rubbed repetitively as method of tactile stimulation, the frequency of apnea was significantly reduced during repetitive stimulation and the 2 h after the repetitive stimulation (30). In addition, the use of a stochastic resonance mattress is shown to reduce the incidence of apnea (31, 32). However, other methods of stimulation like the use of kinesthetic stimulation have not shown to be effective as treatment for apnea of prematurity in the NICU (33).…”

Section: Discussionmentioning

confidence: 99%

Tactile Stimulation to Stimulate Spontaneous Breathing during Stabilization of Preterm Infants at Birth: A Retrospective Analysis

et al. 2017

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Background and aimsTactile maneuvers to stimulate breathing in preterm infants are recommended during the initial assessment at birth, but it is not known how often and how this is applied. We evaluated the occurrence and patterns of tactile stimulation during stabilization of preterm infants at birth.MethodsRecordings of physiological parameters and videos of infants <32 weeks gestational age were retrospectively analyzed. Details of tactile stimulation during the first 7 min after birth (timing, duration, type, and indication) were noted.ResultsStimulation was performed in 164/245 (67%) infants. The median (IQR) GA was 28 6/7 (27 2/7–30 1/7) weeks, birth weight 1,153 (880–1,385) g, Apgar score at 5 min was 8 (7–9), 140/245 (57%) infants were born after cesarean section, and 134/245 (55%) were male. There were no significant differences between the stimulated and the non-stimulated infants with regard to basic characteristics. In the stimulated infants, the first episode of stimulation was given at a median (IQR) of 114 (73–182) s after birth. Stimulation was repeated 3 (1–5) times, with a median (IQR) duration of 8 (4–16) s and a total duration of 32 (15–64) s. Modes of stimulation were: rubbing (68%) or flicking (2%) the soles of the feet, rubbing the back (12%), a combination (9%), or other (8%). In 67% of the stimulation episodes, a clear indication was noted (25% bradycardia, 57% apnea, 48% hypoxemia, 43% combination) and an effect was observed in 18% of these indicated stimulation episodes. A total effect of all stimulation episodes per infant remains unclear, but infants who did not receive stimulation were more often intubated in the delivery room (14/79 (18%) vs 12/164 (7%), p < 0.05).ConclusionThere was a large variation in the use of tactile stimulation in preterm infants during stabilization at birth. In most cases, there was an indication for stimulation, but only in a small proportion an effect could be observed.

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Section: Discussionmentioning

confidence: 99%

Tactile Stimulation to Stimulate Spontaneous Breathing during Stabilization of Preterm Infants at Birth: A Retrospective Analysis

et al. 2017

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“…A recent study of 36 preterm infants found that unsynchronised, stochastic resonance stimulation provided by a specialised mattress leads to a decrease in apnoea by one half 37. There were associated decreases in the number, duration and depth of O 2 desaturation events.…”

Section: Treatmentmentioning

confidence: 97%

Treatment options for apnoea of prematurity

Morton

Smith

2016

Arch Dis Child Fetal Neonatal Ed

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Apnoea of prematurity (AOP) affects almost all infants born at <28 weeks gestation or with birth weight <1000 g. When untreated, AOP may be associated with negative outcomes. Because of these negative outcomes, effective treatment for AOP is an important part of optimising care of preterm infants. Standard treatment usually involves xanthine therapy and respiratory support. Cutting-edge work with stochastic vibrotactile stimulation and new pharmaceutical agents continues to expand therapeutic options. In this article, we review the pathophysiology of AOP, associated conditions and treatment options.

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“…Intermittent hypoxia in preterm infants is associated with a range of complications including retinopathy, developmental delays, and neuropsychiatric disorders [13–15]. To aid clinicians and medical staff, therapeutic interventions, for example as presented in [16, 17], might be most effective if intervention is initiated early in high risk infants. In particular, implementation of algorithms for detection of apnea-bradycardia [18] and their limited success in prediction [13, 19, 20] might help risk-stratify infants for long-term outcomes, alert clinicians for short-term intervention, and ultimately provide automated therapeutic care that reduce the hypoxic-ischemic complications of preterm cardio-respiratory control.…”

Section: Introductionmentioning

confidence: 99%

Predicting Bradycardia in Preterm Infants Using Point Process Analysis of Heart Rate

Gee

Barbieri²,

Paydarfar

et al. 2017

IEEE Trans. Biomed. Eng.

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Objective Episodes of bradycardia are common and recur sporadically in preterm infants, posing a threat to the developing brain and other vital organs. We hypothesize that bradycardias are a result of transient temporal destabilization of the cardiac autonomic control system and that fluctuations in the heart rate signal might contain information that precedes bradycardia. We investigate infant heart rate fluctuations with a novel application of point process theory. Methods In 10 preterm infants, we estimate instantaneous linear measures of the heart rate signal in neonates, use these measures to extract statistical features of bradycardia, and propose a simplistic framework for prediction of bradycardia. Results We present the performance of a prediction algorithm using instantaneous linear measures (mean AUC = 0.79±0.018) for over 440 bradycardia events. The algorithm achieves an average forecast time of 116 seconds prior to bradycardia onset (FPR = 0.15). Our analysis reveals that increased variance in the heart rate signal is a precursor of severe bradycardia. This increase in variance is associated with an increase in power from low content dynamics in the LF band (0.04–0.2 Hz) and lower multiscale entropy values prior to bradycardia. Conclusion Point process analysis of the heartbeat time series reveals instantaneous measures that can be used to predict infant bradycardia prior to onset. Significance Our findings are relevant to risk stratification, predictive monitoring, and implementation of preventative strategies for reducing morbidity and mortality associated with bradycardia in neonatal intensive care units.

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Stochastic Resonance Effects on Apnea, Bradycardia, and Oxygenation: A Randomized Controlled Trial

Abstract: To evaluate the effect of stochastic resonance (SR) stimulation on preterm infant oxygen desaturation, bradycardia, and apnea events. We hypothesized that SR stimulation will reduce these events.

Cited by 29 publications

References 14 publications

Tactile Stimulation to Stimulate Spontaneous Breathing during Stabilization of Preterm Infants at Birth: A Retrospective Analysis

Tactile Stimulation to Stimulate Spontaneous Breathing during Stabilization of Preterm Infants at Birth: A Retrospective Analysis

Treatment options for apnoea of prematurity

Predicting Bradycardia in Preterm Infants Using Point Process Analysis of Heart Rate

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