Targeting survival without morbidity: Heart rate characteristics for oxygen supplementation optimization in neonatal care

IF 2.1 4区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL
Urvi Jhaveri Sanghvi , William E. King , Colm P. Travers , Vivek V. Shukla , Robert L. Schelonka , Namasivayam Ambalavanan , Waldemar A. Carlo , Clyde Wright
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引用次数: 0

Abstract

The preterm newborn is susceptible to many diseases related to oxidative stress, and supplemental oxygen therapy and its interaction with inflammatory processes may be a contributing factor to their underlying pathophysiology. Supplemental oxygen therapy can lead to over-oxygenation, and can complicate ischemia–reperfusion processes, which in turn can promote oxidative stress pathways. We hypothesize that the optimal dose of supplemental oxygen therapy likely varies for each preterm infant based on their unique and developing physiology, and may be adjusted through the assessment autonomic nervous function and pulmonary resilience by measuring heart rate variability. We present preliminary findings demonstrating that among extremely preterm infants with low-to-moderate heart rate characteristics index (HRCi) scores (indicating healthy ANS function) during the first six postnatal days, exposure to a low target oxygen saturation range was associated with decreased risk of the composite outcome of death by 36 weeks postmenstrual age (PMA), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and/or retinopathy of prematurity (ROP). This suggests a novel therapeutic approach to supplemental oxygen delivery in the neonatal intensive care unit (NICU) wherein the HRCi can be leveraged to guide the prescription of individualized target oxygen saturation ranges that are responsive to each infant’s unique and dynamic physiology, minimizing the risks of morbidity and mortality.

以存活率和发病率为目标:新生儿护理中优化补氧的心率特征
早产新生儿易患多种与氧化应激有关的疾病,而补氧疗法及其与炎症过程的相互作用可能是导致其潜在病理生理学的一个因素。补氧疗法会导致过度供氧,并使缺血再灌注过程复杂化,进而促进氧化应激途径。我们假设,根据每个早产儿独特的发育生理特点,补充氧气治疗的最佳剂量可能会有所不同,并可通过测量心率变异性评估自律神经功能和肺恢复能力来进行调整。我们的初步研究结果表明,在出生后前六天心率特征指数(HRCi)得分处于中低水平(表明自律神经功能健康)的极早产儿中,暴露于低目标氧饱和度范围与月龄后 36 周前死亡(PMA)、坏死性小肠结肠炎(NEC)、支气管肺发育不良(BPD)和/或早产儿视网膜病变(ROP)等综合结果的风险降低有关。这就为新生儿重症监护室(NICU)的补给氧提供了一种新的治疗方法,即利用 HRCi 来指导个体化目标氧饱和度范围的处方,以适应每个婴儿独特而动态的生理特点,最大限度地降低发病率和死亡率的风险。
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来源期刊
Medical hypotheses
Medical hypotheses 医学-医学:研究与实验
CiteScore
10.60
自引率
2.10%
发文量
167
审稿时长
60 days
期刊介绍: Medical Hypotheses is a forum for ideas in medicine and related biomedical sciences. It will publish interesting and important theoretical papers that foster the diversity and debate upon which the scientific process thrives. The Aims and Scope of Medical Hypotheses are no different now from what was proposed by the founder of the journal, the late Dr David Horrobin. In his introduction to the first issue of the Journal, he asks ''what sorts of papers will be published in Medical Hypotheses? and goes on to answer ''Medical Hypotheses will publish papers which describe theories, ideas which have a great deal of observational support and some hypotheses where experimental support is yet fragmentary''. (Horrobin DF, 1975 Ideas in Biomedical Science: Reasons for the foundation of Medical Hypotheses. Medical Hypotheses Volume 1, Issue 1, January-February 1975, Pages 1-2.). Medical Hypotheses was therefore launched, and still exists today, to give novel, radical new ideas and speculations in medicine open-minded consideration, opening the field to radical hypotheses which would be rejected by most conventional journals. Papers in Medical Hypotheses take a standard scientific form in terms of style, structure and referencing. The journal therefore constitutes a bridge between cutting-edge theory and the mainstream of medical and scientific communication, which ideas must eventually enter if they are to be critiqued and tested against observations.
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