Predicting 2-y outcome in preterm infants using early multimodal physiological monitoring

Abstract

Background: Preterm infants are at risk of adverse outcome. The aim of this study is to develop a multimodal model, including physiological signals from the first days of life, to predict 2-y outcome in preterm infants. Methods: Infants <32 wk gestation had simultaneous multichannel electroencephalography (EEG), peripheral oxygen saturation (SpO 2 ), and heart rate (HR) monitoring. EEG grades were combined with gestational age (GA) and quantitative features of HR and SpO 2 in a logistic regression model to predict outcome. Bayley Scales of Infant Development-III assessed 2-y neurodevelopmental outcome. A clinical course score, grading infants at discharge as high or low morbidity risk, was used to compare performance with the model. results: Forty-three infants were included: 27 had good outcomes, 16 had poor outcomes or died. While performance of the model was similar to the clinical course score graded at discharge, with an area under the receiver operator characteristic (AUC) of 0.83 (95% confidence intervals (CI): 0.69-0.95) vs. 0.79 (0.66-0.90) (P = 0.633), the model was able to predict 2-y outcome days after birth. conclusion: Quantitative analysis of physiological signals, combined with GA and graded EEG, shows potential for predicting mortality or delayed neurodevelopment at 2 y of age.

Temporal evolution of quantitative EEG within 3 days of birth in early preterm infants

“…EEG was recorded using the NicoletOne device (Natus Medical Inc., Pleasanton, CA, USA) with 11 electrodes placed according to the international 10–20 system of electrode configuration. Electrodes covered the frontal, central, temporal, and occipital regions, with a reference electrode at Fz and a ground electrode behind the left ear 56 . Recording started after birth when clinical staff determined the infant was stable and continued for up to 72 h after birth.…”

Automated cot-side tracking of functional brain age in preterm infants

“…Critical time periods for the direction of care are usually the first days after birth, the time of discharge from tertiary care to step-down units, as well as the follow-up visit at near term-equivalent age. The EEG is the best available tool for cot-side assessment of brain function, and it is widely used for early therapeutic decisions as well as the prediction of neurodevelopmental outcome in preterm infants (5)(6)(7)(8)(9). However, the clinical use of EEG in the NICU is complicated by difficulties in interpretation and the availability of expertise to perform interpretation (10).…”

EEG - A Valuable Biomarker of Brain Injury in Preterm Infants

“…A combination of signal processing and the more traditional visual analysis techniques will undoubtedly shed light onto our understanding of the developing brain for years to come [36,[100][101][102][103][104] . In addition, it is now possible to combine other physiological data and complimentary tools with EEG to provide a more comprehensive overview of neonatal brain health [105][106][107] .…”