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J Pediatr. 2014 Nov;165(5):897-902.e1. doi: 10.1016/j.jpeds.2014.06.008. Epub 2014 Jul 16.

New time-frequency method for cerebral autoregulation in newborns: predictive capacity for clinical outcomes.

Author information

  • 1Department of Neonatology, La Paz University Hospital, Madrid, Spain; Center for Biomedical Technology, Technical University, Madrid, Spain. Electronic address: joan.riera@me.com.
  • 2Biomedical Research Foundation, La Paz University Hospital, Madrid, Spain.
  • 3Center for Biomedical Technology, Technical University, Madrid, Spain; Biomedical Research Networking Center in Bioengineering Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain.
  • 4Department of Neonatology, La Paz University Hospital, Madrid, Spain.
  • 5Division of Statistics, La Paz University Hospital, Madrid, Spain.

Abstract

OBJECTIVE:

To describe an alternative analysis in the frequency-domain of the temporal relationship between 2 biological signals and evaluate the method's predictive capacity for classifying infants at risk for an adverse outcome.

STUDY DESIGN:

We studied 54 infants (mean gestational age 27 weeks) with invasive mean arterial blood pressure monitoring. The bivariate autoregressive spectral coherence (BiAR-COH) method and the spectral coherence methods were used to analyze the relationship between spontaneous changes in mean arterial blood pressure and the near-infrared tissue oxygenation index.

RESULTS:

The mean postnatal age at the beginning and end of the autoregulation study was 6.0 (3.0) and 29.0 (7.5) hours, respectively. The BiAR-COH was superior to the spectral coherence in predicting low superior vena cava (SVC) flow (≤ 41 mL/kg per minute), with an area under the receiver operating characteristic curve of 0.84 (95% CI, 0.77-0.90; P < .001). The BiAR-COH threshold for identifying low SVC flow was 0.577, with 0.8 sensitivity and 0.76 specificity. After adjusting for the repeated measures effect (multiple epochs) in a given patient, the averaged BiAR-COH per patient and averaged COH per patient were calculated as the average value per patient. The pBiAR-COH (but not the pCOH) was associated with intraventricular hemorrhage grades 3 and 4 and predicted mortality.

CONCLUSIONS:

The BiAR-COH classifier identifies low SVC flow infants who are at risk for brain hypoperfusion. The BiAR-COH is superior to frequency domain methods in predicting adverse outcomes in infants.

Copyright © 2014 Elsevier Inc. All rights reserved.

[PubMed - indexed for MEDLINE]
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