Pre-Vent: the prematurity-related ventilatory control study

Abstract

Background: The increasing incidence of bronchopulmonary dysplasia in premature babies may be due in part to immature ventilatory control, contributing to hypoxemia. The latter responds to ventilation and/or oxygen therapy, treatments associated with adverse sequelae. This is an overview of the Prematurity-Related Ventilatory Control Study which aims to analyze the under-utilized cardiorespiratory continuous waveform monitoring data to delineate mechanisms of immature ventilatory control in preterm infants and identify predictive markers. Methods: Continuous ECG, heart rate, respiratory and oxygen saturation data will be collected throughout the NICU stay in 500 infants <29wks gestation across 5 centers. Mild permissive hypercapnia, and hyperoxia and/or hypoxia assessments will be conducted in a subcohort of infants (28 days and 52wks) along with inpatient questionnaires, urine, serum, and DNA samples. Results: Primary outcomes will be respiratory status at 40wks and quantitative measures of immature breathing plotted on a standard curve for infants matched at 36–37wks. Physiologic and/or biologic determinants will be collected to enhance the predictive model linking ventilatory control to outcomes. Conclusion: By incorporating bedside monitoring variables along with biomarkers that predict respiratory outcomes we aim to elucidate individualized cardiopulmonary phenotypes and mechanisms of ventilatory control contributing to adverse respiratory outcomes in premature infants.

Central Apnea of Prematurity: Does Sex Matter?

“…Central ABDs are then detected as periods of very low variance in the CI signal lasting at least 10 seconds that are accompanied by both bradycardia (HR < 100 beats per minute) and desaturation (SpO 2 < 80%). 22 Algorithm ABD detection was performed on archived data after infants were discharged, and the data were not available to clinicians for clinical care decisions.…”

Cerebral cortical-autonomic connectivity in newborns: a first step to determine the autonomic signatures with advancing age?

“…If provided, neonatal intensive care unit (NICU) monitoring with the bedside Bedmaster™ continuous data acquisition device (including monitoring of breathing, ECG, blood pressure, cerebral regional blood flow/oxygenation, hemoglobin saturation/pulse waveform, and end-tidal carbon dioxide, all on a breath-by-breath and beat-to-beat basis), both during wakefulness and sleep, can offer an opportunity for big data analysis to identify patterns of autonomic maturation. This is indeed the focus of our NIH-funded prematurity-related ventilatory control study [4]. Once discharged, whether preterm or term, wireless wearable devices with a skin-like flexible interface and wireless technology can record breathing, ECG and heart rate, temperature, pulse acceleration time (as a proxy for blood pressure), temperature, oximetry, and a proxy for cerebral regional blood flow and oxygenation during wakefulness and sleep [2,3,7,10].…”

Kangaroo father care: A pilot feasibility study of physiologic, biologic, and psychosocial measures to capture the effects of father–infant and mother–infant skin‐to‐skin contact in the Neonatal Intensive Care Unit

“…Apneas (Lee et al., 2012) and periodic breathing (Mohr et al., 2015) were detected in the respiratory waveform using automated algorithms via implementation in tools developed by the University of Virginia for the Pre‐Vent multi‐center NHLBI‐funded study (Dennery et al., 2019). Apneas lasting longer than 10 s were included, and the total time in apnea was taken as a fraction of the total time of respiratory data available for the KC period versus other times available.…”