Comparison of oxygen supplementation in very preterm infants: Variations of oxygen saturation features and their application to hypoxemic episode based risk stratification

BackgroundOxygen supplementation is commonly used to maintain oxygen saturation (SpO2) levels in preterm infants within target ranges to reduce intermittent hypoxemic (IH) events, which are associated with short- and long-term morbidities. There is not much information available about differences in oxygenation patterns in infants undergoing such supplementations nor their relation to observed IH events. This study aimed to describe oxygenation characteristics during two types of supplementation by studying SpO2 signal features and assess their performance in hypoxemia risk screening during NICU monitoring.Subjects and methodsSpO2 data from 25 infants with gestational age <32 weeks and birthweight <2,000 g who underwent a cross over trial of low-flow nasal cannula (NC) and digitally-set servo-controlled oxygen environment (OE) supplementations was considered in this secondary analysis. Features pertaining to signal distribution, variability and complexity were estimated and analyzed for differences between the supplementations. Univariate and regularized multivariate logistic regression was applied to identify relevant features and develop screening models for infants likely to experience a critically high number of IH per day of observation. Their performance was assessed using area under receiver operating curves (AUROC), accuracy, sensitivity, specificity and F1 scores.ResultsWhile most SpO2 measures remained comparable during both supplementations, signal irregularity and complexity were elevated while on OE, pointing to more volatility in oxygen saturation during this supplementation mode. In addition, SpO2 variability measures exhibited early prognostic value in discriminating infants at higher risk of critically many IH events. Poincare plot variability at lag 1 had AUROC of 0.82, 0.86, 0.89 compared to 0.63, 0.75, 0.81 for the IH number, a clinical parameter at observation times of 30 min, 1 and 2 h, respectively. Multivariate models with two features exhibited validation AUROC > 0.80, F1 score > 0.60 and specificity >0.85 at observation times ≥ 1 h. Finally, we proposed a framework for risk stratification of infants using a cumulative risk score for continuous monitoring.ConclusionAnalysis of oxygen saturation signal routinely collected in the NICU, may have extensive applications in inferring subtle changes to cardiorespiratory dynamics under various conditions as well as in informing clinical decisions about infant care

Signatures of Higher Functions of Brain Dynamics in Electroencephalogram: A Nonlinear Analysis

The brain with its highly complex structure made up of simple units,imterconnected information pathways and specialized functions has always been an object of mystery and sceintific fascination for physiologists,neuroscientists and lately to mathematicians and physicists. The stream of biophysicists are engaged in building the bridge between the biological and physical sciences guided by a conviction that natural scenarios that appear extraordinarily complex may be tackled by application of principles from the realm of physical sciences. In a similar vein, this report aims to describe how nerve cells execute transmission of signals ,how these are put together and how out of this integration higher functions emerge and get reflected in the electrical signals that are produced in the brain.Viewing the E E G Signal through the looking glass of nonlinear theory, the dynamics of the underlying complex system-the brain ,is inferred and significant implications of the findings are explored.International School of Photonics, Cochin University of Science and Technolog

Complexity quantification of dense array EEG using sample entropy analysis

n this paper, a time series complexity analysis of dense array electroencephalogram signals is carried out using the recently introduced Sample Entropy (SampEn) measure. This statistic quantifies the regularity in signals recorded from systems that can vary from the purely deterministic to purely stochastic realm. The present analysis is conducted with an objective of gaining insight into complexity variations related to changing brain dynamics for EEG recorded from the three cases of passive, eyes closed condition, a mental arithmetic task and the same mental task carried out after a physical exertion task. It is observed that the statistic is a robust quantifier of complexity suited for short physiological signals such as the EEG and it points to the specific brain regions that exhibit lowered complexity during the mental task state as compared to a passive, relaxed state. In the case of mental tasks carried out before and after the performance of a physical exercise, the statistic can detect the variations brought in by the intermediate fatigue inducing exercise period. This enhances its utility in detecting subtle changes in the brain state that can find wider scope for applications in EEG based brain studies.Cochin University of Science and Technology & Florida Atlantic Universit