Heart Rate and Pulse Oximetry Dynamics in the First Week after Birth in Neonatal Intensive Care Unit Patients and the Risk of Cerebral Palsy

Abstract

Objective Infants in the neonatal intensive care unit (NICU) are at high risk of adverse neuromotor outcomes. Atypical patterns of heart rate (HR) and pulse oximetry (SpO2) may serve as biomarkers for risk assessment for cerebral palsy (CP). The purpose of this study was to determine whether atypical HR and SpO2 patterns in NICU patients add to clinical variables predicting later diagnosis of CP. Study Design This was a retrospective study including patients admitted to a level IV NICU from 2009 to 2017 with archived cardiorespiratory data in the first 7 days from birth to follow-up at >2 years of age. The mean, standard deviation (SD), skewness, kurtosis and cross-correlation of HR and SpO2 were calculated. Three predictive models were developed using least absolute shrinkage and selection operator regression (clinical, cardiorespiratory and combined model), and their performance for predicting CP was evaluated. Results Seventy infants with CP and 1,733 controls met inclusion criteria for a 3.8% population prevalence. Area under the receiver operating characteristic curve for CP prediction was 0.7524 for the clinical model, 0.7419 for the vital sign model, and 0.7725 for the combined model. Variables included in the combined model were lower maternal age, outborn delivery, lower 5-minute Apgar's score, lower SD of HR, and more negative skewness of HR. Conclusion In this study including NICU patients of all gestational ages, HR but not SpO2 patterns added to clinical variables to predict the eventual diagnosis of CP. Identification of risk of CP within the first few days of life could result in improved therapy resource allocation and risk stratification in clinical trials of new therapeutics. Key Points

Highly comparative time series analysis of oxygen saturation and heart rate to predict respiratory outcomes in extremely preterm infants

“…Models have also been developed for other adverse outcomes during NICU stay including death (Sullivan et al 2016, Niestroy et al 2022, bronchopulmonary dysplasia (BPD) (Raffay et al 2019, Ramanand et al 2023, and retinopathy of prematurity (Di Fiore et al 2010, 2012. Vital sign data during an infant's stay has also been shown to predict long-term outcomes of cognitive impairment (Poets 2015), cerebral palsy (Letzkus et al 2022), and autism (Blackard et al 2021).…”

Highly comparative time series analysis of oxygen saturation and heart rate to predict respiratory outcomes in extremely preterm infants

“…Models have also been developed for other adverse outcomes during NICU stay including death (Sullivan et al 2016, 2018, Niestroy et al 2022), bronchopulmonary dysplasia (BPD) (Raffay et al 2019, Gentle et al 2023, Ramanand et al 2023), and retinopathy of prematurity (Di Fiore et al 2010, 2012). Vital sign data during an infant’s stay has also been shown to predict long-term outcomes of cognitive impairment (Poets et al 2015), cerebral palsy (Letzkus et al 2022), and autism (Blackard et al 2021).…”