Heart Rate Variability in the Perinatal Period: A Critical and Conceptual Review.
Heart Rate Variability in the Perinatal Period: A Critical and Conceptual Review.
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DOI：
10.3389/fnins.2020.561186
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发表时间：
2020
影响因子：
4.3
通讯作者：
Manzotti A
中科院分区：
文献类型：
--
作者：
Chiera M;Cerritelli F;Casini A;Barsotti N;Boschiero D;Cavigioli F;Corti CG;Manzotti A
新生儿重症监护病房 (NICU) 极大地扩展了技术的使用。需要在不适、疼痛和并发症（例如脓毒症）发生之前准确诊断它们。虽然特定的治疗是可能的，但它们通常是耗时的、侵入性的或痛苦的，对婴儿的发育有不利影响。在过去 40 年中，心率变异性 (HRV) 已成为一种监测新生儿和婴儿的无创测量方法，但仍未得到充分利用。因此，本文旨在回顾 HRV 在新生儿学中的效用以及可用于评估 HRV 的工具，展示 HRV 如何成为未来几年的创新工具。当持续监测时，HRV可以帮助评估婴儿的整体健康状况和神经发育，以检测与压力/疼痛相关的行为或病理状况，例如呼吸窘迫综合征和高胆红素血症，以确定何时执行减轻婴儿压力/疼痛的程序和干预措施，例如治疗性低温，并避免严重并发症，例如败血症和坏死性小肠结肠炎，从而降低死亡率。根据文献和以往的经验，在 NICU 中有效引入 HRV 的第一步可能是使用光电体积描记法的监测系统，该系统成本低、无创，并显示一个或几个具有良好临床实用性的指标。然而，为了充分利用 HRV 的临床潜力并大幅改善新生儿护理，监测系统必须依赖现代生物信息学（机器学习和人工智能算法），它可以轻松整合婴儿的 HRV 指标、生命体征，尤其是既往病史，从而制定能够有效监测和预测婴儿临床状况的模型。因此，医院和机构必须在产科、新生儿科和儿科之间建立紧密的合作：这样，围产期各个阶段（从受孕到生命最初几年）的医疗保健才能真正得到改善，因为有关患者健康的信息可以在不同专业人员之间自由流动，并且可以整合这些部门记录的数据进行高质量的研究。
Neonatal intensive care units (NICUs) greatly expand the use of technology. There is a need to accurately diagnose discomfort, pain, and complications, such as sepsis, mainly before they occur. While specific treatments are possible, they are often time-consuming, invasive, or painful, with detrimental effects for the development of the infant. In the last 40 years, heart rate variability (HRV) has emerged as a non-invasive measurement to monitor newborns and infants, but it still is underused. Hence, the present paper aims to review the utility of HRV in neonatology and the instruments available to assess it, showing how HRV could be an innovative tool in the years to come. When continuously monitored, HRV could help assess the baby’s overall wellbeing and neurological development to detect stress-/pain-related behaviors or pathological conditions, such as respiratory distress syndrome and hyperbilirubinemia, to address when to perform procedures to reduce the baby’s stress/pain and interventions, such as therapeutic hypothermia, and to avoid severe complications, such as sepsis and necrotizing enterocolitis, thus reducing mortality. Based on literature and previous experiences, the first step to efficiently introduce HRV in the NICUs could consist in a monitoring system that uses photoplethysmography, which is low-cost and non-invasive, and displays one or a few metrics with good clinical utility. However, to fully harness HRV clinical potential and to greatly improve neonatal care, the monitoring systems will have to rely on modern bioinformatics (machine learning and artificial intelligence algorithms), which could easily integrate infant’s HRV metrics, vital signs, and especially past history, thus elaborating models capable to efficiently monitor and predict the infant’s clinical conditions. For this reason, hospitals and institutions will have to establish tight collaborations between the obstetric, neonatal, and pediatric departments: this way, healthcare would truly improve in every stage of the perinatal period (from conception to the first years of life), since information about patients’ health would flow freely among different professionals, and high-quality research could be performed integrating the data recorded in those departments.
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影响因子：
1.8
作者：
Alexandre, C.;De Jonckheere, J.;Storme, L.
通讯作者：
Storme, L.
影响因子：
2.9
作者：
Alonzo, Corrie J.;Nagraj, Vijay P.;Spaeder, Michael C.
通讯作者：
Spaeder, Michael C.
影响因子：
2.5
作者：
Aarts, Lonneke A. M.;Jeanne, Vincent;Verkruysse, Wim
通讯作者：
Verkruysse, Wim
DOI：
10.1016/j.jpeds.2017.12.071
发表时间：
2018-05
期刊：
The Journal of pediatrics
影响因子：
--
作者：
Campbell H;Govindan RB;Kota S;Al-Shargabi T;Metzler M;Andescavage N;Chang T;Vezina G;du Plessis A;Massaro AN
通讯作者：
Massaro AN
通过临床应用审查和分类可变性分析技术。
影响因子：
3.9
作者：
Bravi A;Longtin A;Seely AJ
通讯作者：
Seely AJ