Correlation between cardiorespiratory events and gastro-esophageal reflux in preterm and term infants: Analysis of predisposing factors.

BACKGROUND: The association between cardiorespiratory events (CRE) and gastro-esophageal reflux (GER) among neonates is still controversial. AIMS: To test such an association in preterm and term infants. STUDY DESIGN: Prospective observational study. SUBJECTS: Forty-seven infants with suspected GER and recurrent CRE admitted at a neonatal intensive care unit, who underwent simultaneous and synchronized 24-hour recording of heart rate (HR), peripheral oxygen saturation (SpO2) and pH-impedance monitoring (MII-pH). HR/SpO2 data were filtered to avoid artefactual episodes of hypoxia and hypoperfusion. OUTCOME MEASURES: The main outcome measure was the symptom association probability (SAP), with a 2-minute time window. Infants with positive (>95%) and negative (≤95%) SAP index tests were compared by univariate and multivariate statistics. RESULTS: Median gestational age at birth was 294/7 weeks, median age at study 36 days. We recorded 3341 GER events and 4936 CRE (4710 desaturations, 226 bradycardias); 609/4936 (12%) CRE were temporally associated with GER episodes: 338 preceded and 271 followed GER events. The SAP index was significant in 5/47 (11%) patients. The SAP index including only CRE following GER events was significant in 3/47 (6%). There was no significant difference in the number of acid, weakly acid, non-acid, pH-only events preceding or following CRE between infants with SAP-positive and SAP-negative tests. Infants with positive SAP-index tests compared to those with SAP-negative tests had lower weight gain in the three days preceding the test and tended to have lower birth weight. CONCLUSIONS: GER and CRE were associated in <11% of patients. The evaluation of ponderal growth might be helpful in predicting such an association.

Laser doppler myography (LDMi): A novel non-contact measurement method for the muscle activity.

BACKGROUND AND AIMS: Electromyography (EMG) is considered the gold-standard for the evaluation of muscle activity. Transversal and dimensional changes of the muscle, during muscle activity, generate vibrational phenomena which can be measured by Laser Doppler Vibrometry (LDVi). There is a relationship between muscle contraction and vibrational activity, therefore, some information on fundamental muscle parameters can be assessed without contact with LDVi. In this paper, we explore the possibility to relate the EMG signal causing the muscle contraction and the vibrational activity also measureable on the muscle. A novel non-contact measurement method - Laser Doppler myography (LDMi) - aiming to measure the vibrational behavior of muscle during contraction, is presented herein. Correlations with some parameters normally measured with EMG are reported. MATERIALS AND METHODS: The proposed method has been compared with standard superficial EMG (sEMG). Signals produced with sEMG and laser Doppler myography have been simultaneously acquired and processed to test correlations on a population of 20 healthy volunteers. Tests have been carried out on the flexor carpi ulnaris and the tibialis anterior muscles (left and right). RESULTS: RESULTS show that it is possible to measure: The timing of muscle activation (max differences: 440 ms), the amplitude of the signals acquired during activation respect to the signals during rest (S/N), the correlation between the S/N of the sEMG and LDMi signals at different levels of force (P> 0.89), and to assess muscle fatigue. CONCLUSIONS: LDMi is a valid measurement technique for the assessment of muscle activity and fatigue. It is a non-contact method and this characteristic could suggest its use together with low level laser therapy pre-, intra- and post-LLLT sessions to evaluate the efficacy and effects of the treatments without the need for invasive electrodes.

An optical measurement method for the simultaneous assessment of respiration and heart rates in preterm infants.

Many conventional medical monitoring devices, while not technically invasive, are nevertheless obtrusive insofar as they require contact with the patient. This obtrusiveness sometimes poses problems in daily clinical practice. The need for contact with electrodes or transducers is particularly relevant in the case of patients recovering in intensive care units where continuous monitoring is required, in turn requiring continuous direct transducer contact for prolonged periods. Among the many physiological parameters commonly acquired, the respiratory and the cardiac rates of the patients are of primary importance. Typically these two parameters are measured respectively using spirometry and electrocardiography (ECG), both involving obtrusive measurement systems requiring contact with the patient with an air conduit and electrodes. This paper presents an optical measurement method for the simultaneous assessment of respiration and heart rates based on the measurement of the chest wall movements, associated with inspiratory/expiratory activities of the lungs and by the mechanical pumping action of the heart. The measurement method has been adapted for use with preterm infants and it has been applied to 55 patients recovering in a Neonatal Intensive Care Unit. The method is based on the use of a laser Doppler vibrometer (LDVi) pointed at the left, ventral thoracic surface of the patient. LDVi-based measures of respiration and heart rate have been simultaneously acquired for each patient, in parallel with the same quantities acquired using conventional reference instrumentation (flow-meter and ECG) for comparison purposes. Results show that for respiration rate, differences with respect to the spirometer data are <3%, while for the cardiac rate they are <6% with respect to ECG data. The method proposed in this paper has the advantage of requiring no contact with the patient. Moreover, it supports, by means of a single instrument, the simultaneous measurement of respiration and heart rates, thus reducing the burden of the number of electrodes, transducers, and other instrumentation that must be applied to the patient--a consideration that is particularly important in the Neonatal Intensive Care Unit. In addition to the measurement of respiration rate, we also describe the sensitivity of the LDVi method in detecting key respiration events (irregular inspiration/expiration cycles, apneas, and hiccups) which are relevant to clinical monitoring.

Class III dento-skeletal anomalies: rotational growth and treatment timing.

AIM: The interception of a Class III malocclusion requires a long-term growth prediction in order to estimate the subject's evolution from the prepubertal phase to adulthood. The aim of this retrospective longitudinal study was to highlight the differences in facial morphology in relation to the direction of mandibular growth in a sample of subjects with Class III skeletal anomalies divided on the basis of their Petrovic's auxological categories and rotational types. MATERIALS AND METHODS: The study involved 20 patients (11 females and 9 males) who started therapy before reaching their pubertal peak and were followed up for a mean of 4.3 years (range: 3.9-5.5 years). RESULTS: Despite the small sample size, the definition of the rotational type of growth was the main diagnostic element for setting the correct individualised therapy. CONCLUSION: We therefore believe that the observation of a larger sample would reinforce the diagnostic-therapeutic validity of Petrovic's auxological categories, allow an evaluation off all rotational types, and improve the statistical significance of the results obtained.