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Am J Perinatol 2024; 41(S 01): e528-e535
DOI: 10.1055/s-0042-1756335
Original Article

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

Lisa Letzkus 
1   Department of Pediatrics, Neurodevelopmental and Behavioral Pediatrics, University of Virginia Children's, University of Virginia School of Medicine, Charlottesville, Virginia
,
Karen Fairchild
2   Department of Pediatrics, Neonatology, University of Virginia Children's, University of Virginia School of Medicine, Charlottesville, Virginia
,
Genevieve Lyons
3   Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
,
Harshini Pyata
4   Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Sarah Ratcliffe
3   Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
,
Doug Lake
5   Department of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
› Author Affiliations
Funding This work was supported by iTHRIV scholar, UL1TR003015, iTHRIV scholar, KL2TR003016, NCATS award, and UL1TR003015.
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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

  • SD and skewness of HR have some added predictive value of later diagnosis of CP.

  • SpO2 measures do not add to CP prediction.

  • Combining clinical variables with early HR measures may improve the prediction of later CP.

Keywords

cerebral palsy - heart rate - oxygen saturation - neonatal - prediction - risk

Ethical Approval

Ethical approval was provided by the Institutional Review Board of University of Virginia in advance of implementation. The waiver of consent was approved.


Supplementary Material



Publication History

Received: 19 January 2022

Accepted: 06 July 2022

Article published online:
29 September 2022

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