scholarly journals Non-contact physiological monitoring of preterm infants in the Neonatal Intensive Care Unit

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Mauricio Villarroel ◽  
Sitthichok Chaichulee ◽  
João Jorge ◽  
Sara Davis ◽  
Gabrielle Green ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Heart Rate ◽  
Respiratory Rate ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Mean Absolute Error ◽  
Vital Signs ◽  
Absolute Error ◽  
Video Camera ◽  
The Mean

AbstractThe implementation of video-based non-contact technologies to monitor the vital signs of preterm infants in the hospital presents several challenges, such as the detection of the presence or the absence of a patient in the video frame, robustness to changes in lighting conditions, automated identification of suitable time periods and regions of interest from which vital signs can be estimated. We carried out a clinical study to evaluate the accuracy and the proportion of time that heart rate and respiratory rate can be estimated from preterm infants using only a video camera in a clinical environment, without interfering with regular patient care. A total of 426.6 h of video and reference vital signs were recorded for 90 sessions from 30 preterm infants in the Neonatal Intensive Care Unit (NICU) of the John Radcliffe Hospital in Oxford. Each preterm infant was recorded under regular ambient light during daytime for up to four consecutive days. We developed multi-task deep learning algorithms to automatically segment skin areas and to estimate vital signs only when the infant was present in the field of view of the video camera and no clinical interventions were undertaken. We propose signal quality assessment algorithms for both heart rate and respiratory rate to discriminate between clinically acceptable and noisy signals. The mean absolute error between the reference and camera-derived heart rates was 2.3 beats/min for over 76% of the time for which the reference and camera data were valid. The mean absolute error between the reference and camera-derived respiratory rate was 3.5 breaths/min for over 82% of the time. Accurate estimates of heart rate and respiratory rate could be derived for at least 90% of the time, if gaps of up to 30 seconds with no estimates were allowed.

scholarly journals Non-contact vital-sign monitoring of patients undergoing haemodialysis treatment

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Mauricio Villarroel ◽  
João Jorge ◽  
David Meredith ◽  
Sheera Sutherland ◽  
Chris Pugh ◽  
...  
Keyword(s):  
Heart Rate ◽  
Respiratory Rate ◽  
Reference Values ◽  
Mean Absolute Error ◽  
Absolute Error ◽  
Recording Time ◽  
Wide Range ◽  
Auto Regressive ◽  
The Mean ◽  
Haemodialysis Treatment

Abstract A clinical study was designed to record a wide range of physiological values from patients undergoing haemodialysis treatment in the Renal Unit of the Churchill Hospital in Oxford. Video was recorded for a total of 84 dialysis sessions from 40 patients during the course of 1 year, comprising an overall video recording time of approximately 304.1 h. Reference values were provided by two devices in regular clinical use. The mean absolute error between the heart rate estimates from the camera and the average from two reference pulse oximeters (positioned at the finger and earlobe) was 2.8 beats/min for over 65% of the time the patient was stable. The mean absolute error between the respiratory rate estimates from the camera and the reference values (computed from the Electrocardiogram and a thoracic expansion sensor—chest belt) was 2.1 breaths/min for over 69% of the time for which the reference signals were valid. To increase the robustness of the algorithms, novel methods were devised for cancelling out aliased frequency components caused by the artificial light sources in the hospital, using auto-regressive modelling and pole cancellation. Maps of the spatial distribution of heart rate and respiratory rate information were developed from the coefficients of the auto-regressive models. Most of the periods for which the camera could not produce a reliable heart rate estimate lasted under 3 min, thus opening the possibility to monitor heart rate continuously in a clinical environment.

scholarly journals Effect of positioning on physiological parameters on low birth weight preterm babies in neonatal intensive care unit

2019 ◽  
Vol 10 (4) ◽  
pp. 2800-2804 ◽  
Author(s):  
Alice Jeba J ◽  
Senthil Kumar S ◽  
Shivaprakash sosale
Keyword(s):  
Intensive Care Unit ◽  
Heart Rate ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Saturation Level ◽  
Oxygen Saturation Level

Preterm infants are babies who are delivered before the completion of 37 weeks gestation period. They are born with immature functioning of the brain. In  Neonatal Intensive Care Unit (NICU), these infants receives many environmental stimuli, and their comfort will be disturbed. These various sensory stimulus received in NICU influence the functional and neurodevelopmental outcome of these infants and also their quality of life. So this study was intended to evaluate the axillary temperature, heart rate, respiratory rate and oxygen saturation level of these infants prior to nesting and after nesting at the 60th minute. Forty preterm infants who fulfilled the criteria of selection were included in the study by simple random sampling and segregated into case and control groups by blocked randomization. Data was collected and recorded. The temperature was recorded by a digital thermometer, respiratory rate was counted by the number of times the infants' chest rises, heart rate and oxygen saturation readings from the pulse oximeter. The result of the study showed that there was statistically significant effect of nesting at 60th minute, temperature (t=5.03966,p<0.05), respiratory rate(t= -2.13,p<0.05) and heart rate (t=-2.59766,p<0.05). But the effect was not significant on oxygen saturation level (t=1.2,p=0.238).  Hence this study result supports the use of nesting in NICU.

scholarly journals Non-contact physiological monitoring of post-operative patients in the intensive care unit

2022 ◽  
Vol 5 (1) ◽  
Author(s):  
João Jorge ◽  
Mauricio Villarroel ◽  
Hamish Tomlinson ◽  
Oliver Gibson ◽  
Julie L. Darbyshire ◽  
...  
Keyword(s):  
Heart Rate ◽  
Respiratory Rate ◽  
Vital Sign ◽  
Vital Signs ◽  
Reference Value ◽  
Absolute Error ◽  
Video Camera ◽  
Clinical Observations ◽  
Operative Care ◽  
Respiratory Events

AbstractProlonged non-contact camera-based monitoring in critically ill patients presents unique challenges, but may facilitate safe recovery. A study was designed to evaluate the feasibility of introducing a non-contact video camera monitoring system into an acute clinical setting. We assessed the accuracy and robustness of the video camera-derived estimates of the vital signs against the electronically-recorded reference values in both day and night environments. We demonstrated non-contact monitoring of heart rate and respiratory rate for extended periods of time in 15 post-operative patients. Across day and night, heart rate was estimated for up to 53.2% (103.0 h) of the total valid camera data with a mean absolute error (MAE) of 2.5 beats/min in comparison to two reference sensors. We obtained respiratory rate estimates for 63.1% (119.8 h) of the total valid camera data with a MAE of 2.4 breaths/min against the reference value computed from the chest impedance pneumogram. Non-contact estimates detected relevant changes in the vital-sign values between routine clinical observations. Pivotal respiratory events in a post-operative patient could be identified from the analysis of video-derived respiratory information. Continuous vital-sign monitoring supported by non-contact video camera estimates could be used to track early signs of physiological deterioration during post-operative care.

scholarly journals Prospective Validation of Smartphone-based Heart Rate and Respiratory Rate Measurement Algorithms

2021 ◽  
Author(s):  
Sean Bae ◽  
Silviu Borac ◽  
Yunus Emre ◽  
Jonathan Wang ◽  
Jiang Wu ◽  
...  
Keyword(s):  
Heart Rate ◽  
Respiratory Rate ◽  
Vital Signs ◽  
Absolute Error ◽  
Medical Settings ◽  
Post Exercise ◽  
Specialized Equipment ◽  
The Mean ◽  
Respiratory Conditions ◽  
Absolute Percent Error

Abstract Measuring vital signs plays a key role in both patient care and wellness, but can be challenging outside of medical settings due to the lack of specialized equipment. In this study, we prospectively evaluated smartphone camera-based techniques for measuring heart rate (HR) and respiratory rate (RR) for consumer wellness use. HR was measured by placing the finger over the rear-facing camera, while RR was measured via a video of the participants sitting still in front of the front-facing camera. In the HR study of 95 participants (with a protocol that included both measurements at rest and post exercise), the mean absolute percent error (MAPE) ± standard deviation of the measurement was 1.6% ± 4.3%, which was significantly lower than the pre-specified goal of 5%. No significant differences in the MAPE were present across colorimeter-measured skin-tone subgroups: 1.8% ± 4.5% for very light to intermediate, 1.3% ± 3.3% for tan and brown, and 1.8% ± 4.9% for dark. In the RR study of 50 participants, the mean absolute error (MAE) was 0.78 ± 0.61 breaths/min, which was significantly lower than the pre-specified goal of 3 breath/min. The MAE was low in both healthy participants (0.70 ± 0.67 breaths/min), and participants with chronic respiratory conditions (0.80 ± 0.60 breaths/min). These results validate the accuracy of our smartphone camera-based techniques to measure HR and RR across a range of pre-defined subgroups.

scholarly journals Prospective validation of smartphone-based heart rate and respiratory rate measurement algorithms

2021 ◽  
Author(s):  
Sean Bae ◽  
Silviu Borac ◽  
Yunus Emre ◽  
Jonathan Wang ◽  
Jiang Wu ◽  
...  
Keyword(s):  
Heart Rate ◽  
Respiratory Rate ◽  
Vital Signs ◽  
Absolute Error ◽  
Medical Settings ◽  
Post Exercise ◽  
Specialized Equipment ◽  
The Mean ◽  
Respiratory Conditions ◽  
Absolute Percent Error

AbstractMeasuring vital signs plays a key role in both patient care and wellness, but can be challenging outside of medical settings due to the lack of specialized equipment. In this study, we prospectively evaluated smartphone camera-based techniques for measuring heart rate (HR) and respiratory rate (RR) for consumer wellness use. HR was measured by placing the finger over the rear-facing camera, while RR was measured via a video of the participants sitting still in front of the front-facing camera. In the HR study of 95 participants (with a protocol that included both measurements at rest and post exercise), the mean absolute percent error (MAPE) ± standard deviation of the measurement was 1.6% ± 4.3%, which was significantly lower than the pre-specified goal of 5%. No significant differences in the MAPE were present across colorimeter-measured skin-tone subgroups: 1.8% ± 4.5% for very light to intermediate, 1.3% ± 3.3% for tan and brown, and 1.8% ± 4.9% for dark. In the RR study of 50 participants, the mean absolute error (MAE) was 0.78 ± 0.61 breaths/min, which was significantly lower than the pre-specified goal of 3 breath/min. The MAE was low in both healthy participants (0.70 ± 0.67 breaths/min), and participants with chronic respiratory conditions (0.80 ± 0.60 breaths/min). Our results validate that smartphone camera-based techniques can accurately measure HR and RR across a range of pre-defined subgroups.

scholarly journals A Review of Deep Learning-Based Contactless Heart Rate Measurement Methods

Sensors ◽  
2021 ◽  
Vol 21 (11) ◽  
pp. 3719
Author(s):  
Aoxin Ni ◽  
Arian Azarang ◽  
Nasser Kehtarnavaz
Keyword(s):  
Heart Rate ◽  
Deep Learning ◽  
Mean Absolute Error ◽  
Absolute Error ◽  
Video Camera ◽  
Measurement Methods ◽  
Rate Measurement ◽  
Learning Methods ◽  
The Public ◽  
Heart Rate Measurement

The interest in contactless or remote heart rate measurement has been steadily growing in healthcare and sports applications. Contactless methods involve the utilization of a video camera and image processing algorithms. Recently, deep learning methods have been used to improve the performance of conventional contactless methods for heart rate measurement. After providing a review of the related literature, a comparison of the deep learning methods whose codes are publicly available is conducted in this paper. The public domain UBFC dataset is used to compare the performance of these deep learning methods for heart rate measurement. The results obtained show that the deep learning method PhysNet generates the best heart rate measurement outcome among these methods, with a mean absolute error value of 2.57 beats per minute and a mean square error value of 7.56 beats per minute.

scholarly journals FRI0618-HPR EFFECTS OF MUSIC THERAPY ON PAIN, ANXIETY, AND VITAL SIGNS IN CHRONIC INFLAMMATORY RHEUMATIC DISEASES PATIENTS DURING BIOLOGICAL DRUGS INFUSION

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 914.2-914
Author(s):  
S. Boussaid ◽  
M. Ben Majdouba ◽  
S. Jriri ◽  
M. Abbes ◽  
S. Jammali ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Music Therapy ◽  
Systolic Blood Pressure ◽  
Respiratory Rate ◽  
Vital Signs ◽  
Biological Therapies ◽  
Biological Drugs ◽  
Pain Anxiety ◽  
The Mean

Background:Music therapy is based on ancient cross-cultural beliefs that music can have a “healing” effect on mind and body. Research determined that listening to music can increase comfort and relaxation, relieve pain, lower distress, reduce anxiety, improve positive emotions and mood, and decrease psychological symptoms. Music therapy has been used greatly in various medical procedures to reduce associated anxiety and pain. Patients have a high level of anxiety when they are in the hospital, this is the case of patients with rheumatic diseases who consult regularly to have intravenous infusion of biological therapies.Objectives:The purpose of this study was to examine the effectiveness of music therapy on pain, anxiety, and vital signs among patients with chronic inflammatory rheumatic diseases during intravenous infusion of biological drugs.Methods:Fifty patients were divided into two groups: The experimental group G1 (n=25) received drug infusion while lestening to soft music (30 minutes); and the control group G2 (n=25) received only drug infusion. Measures include pain, anxiety, vital signs (blood pressure, heart rate and respiratory rate). The pain was measured using visual analogic scale (VAS). The state-trait anxiety inventory (STAI) was used for measuring anxiety, low anxiety ranges from 20 to 39, the moderate anxiety ranges from 40 to 59, and high anxiety ranges from 60 to 80. Vital signs (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], and respiratory rate [RR]) were measured before, during and immediately after the infusion.Statistical package for social sciences (SPSS) was used for analysis.Results:The mean age in G1 was 44.45 years (26-72) with a sex ratio (M/F) of 0.8. Including the 25 patients, 12 had rheumatoid arthritis, 10 had ankylosing spondylitis and 3 had psoriatic arthritis. The mean disease duration was 8 years. In G2, the mean age was 46 years (25-70) with a sex ratio (M/F) of 0.75, 12 had rheumatoid arthritis, 11 had ankylosing spondylitis and 2 had psoriatic arthritis. The mean disease duration was 7.5 years. The biological drugs used were: Infliximab in 30 cases, Tocilizumab in 12 cases and Rituximab in 8 cases.Before the infusion, the patients of experimental group had a mean VAS of 5/10±3, a mean STAI of 50.62±6.01, a mean SBP of 13.6 cmHg±1.4, a mean DBP of 8.6 cmHg±1, a mean HR of 85±10 and a mean RR of 18±3. While in control group the mean VAS was 5.5±2, the mean STAI was 50.89±5.5, the mean SBP was 13.4±1.2, the mean DBP was 8.8±1.1, the mean HR was 82±8 and the mean RR was 19±2.During the infusion and after music intervention in G1, the mean STAI became 38.35±5 in G1 versus 46.7±5.2 in G2 (p value=0.022), the mean SBP became 12.1±0.5 in G1 versus 13±1 in G2 (p=0.035), the mean DBP became 8.1±0.8 in G1 versus 8.4±0.9 in G2 (p=0.4), the mean HR became 76±9 in G1 versus 78±7 in G2 (p=0.04) and the mean RR became 17.3±2.1 in G1 versus 18.2±1.7 in G2 (p=0.39).This study found a statistically significant decrease in anxiety, systolic blood pressure and heart rate in patients receiving music interventions during biological therapies infusion, but no significant difference were identified in diastolic blood pressure and respiratory rate.Conclusion:The findings provide further evidence to support the use of music therapy to reduce anxiety, and lower systolic blood pressure and heart rate in patients with rheumatic disease during biological therapies infusion.References:[1] Lin, C., Hwang, S., Jiang, P., & Hsiung, N. (2019).Effect of Music Therapy on Pain After Orthopedic Surgery -A Systematic review and Meta-Analysis. Pain Practice.Disclosure of Interests:None declared

Comparing the effectiveness of mother’s live lullaby and recorded lullaby on physiological responses and sleep of preterm infants: a clinical trial study

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Razyeh Namjoo ◽  
Roghayeh Mehdipour-Rabori ◽  
Behnaz Bagherian ◽  
Monirsadat Nematollahi
Keyword(s):  
Clinical Trial ◽  
Heart Rate ◽  
Sleep Duration ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Physiological Responses ◽  
Physiological Parameters ◽  
Control Group ◽  
Significant Difference ◽  
The Mean

Abstract Objectives Environmental stimuli in neonatal intensive care units can disrupt the physiological stability and sleep of infants. It is essential to perform nursing interventions to reduce the adverse effects of such stimuli. This study aimed to compare the effect of recorded lullabies and mothers’ live lullabies on physiological responses and sleep duration of preterm infants. Methods This study was a randomized clinical trial. The participants were 90 preterm infants selected using convenience sampling. In the intervention groups, music (recorded lullabies and mother’s live lullabies) was played for 14 days, 20 min a day, while the control group did not receive any intervention. The data were collected using physiological criteria and infant sleep checklists before, during, and after the intervention. The data were analyzed using SPSS software (Version 21.0). Results The mean scores of physiological parameters (O2 saturation and heart rate) were not significantly different in the three groups before, during, and after the intervention (p>0.05). However, there was an improvement in O2-saturation and a decrease in the heart rate in two intervention groups. The mean duration of the infants’ overnight sleep was not statistically significant between the groups before the intervention (p>0.05). However, there was a statistically significant difference in the intervention groups after the intervention, (p<0.05), and the infants’ overnight sleep was longer in the recorded-lullaby group than the other two groups. Conclusions Although performing interventions, including recorded lullaby and mother’s live lullaby did not differ significantly with that of the control group in physiological criteria, it can be clinically important. In addition, recorded-lullaby increased the infants’ overnight sleeping. Thus, it is suggested that further studies be conducted to confirm the effect of recorded lullaby and mother’s live lullaby interventions on physiological parameters and sleep duration of hospitalized infants.

scholarly journals Retrospective Review of Transfusion Practices in a Single Neonatal Intensive Care Unit (NICU) Compared to Recent Transfusion Guidelines

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 2145-2145
Author(s):  
Jasmine Smith ◽  
Martha Sola-Visner ◽  
Henry Feldman ◽  
Denise Roe ◽  
Haiyan Cui ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Platelet Transfusion ◽  
University Of Arizona ◽  
The Mean ◽  
One Year ◽  
The University ◽  
Platelet Transfusions

Abstract Background Platelet and packed red blood cell (pRBC) transfusion practices for preterm infants vary significantly worldwide. Recent randomized trials of preterm infants receiving platelet or pRBC transfusions have not shown any benefit with higher compared to lower transfusion thresholds. In the recent PlaNeT2 study published in January 2019, infants receiving platelets at higher thresholds had significantly higher rates of death and major bleeding. These findings raise concern about transfusing adult platelets into a delicately balanced neonatal hemostatic system with relatively hypofunctional platelets as a potential etiology of this multifactorial outcome. In this retrospective review, we aimed to review transfusion practices and outcomes, including thrombosis, in the neonatal intensive care unit (NICU) at the University of Arizona, Tucson in comparison to the PlaNeT2 study. Methods After Institutional Review Board approval, we reviewed the electronic medical records of all neonates born at &lt; 32 weeks gestation in the NICU or transferred to the NICU within 48 hours of birth between January 1, 2018 and December 31, 2019, corresponding to one year pre- and one year post-publication of the PlaNet2 study. For each patient record reviewed, we collected demographics, reviewed whether transfusions occurred, and documented pre-transfusion hemoglobin, platelet count, international normalized ratio, fibrinogen activity level, and clinical outcomes. We recorded the number of transfusions of each product, clinical central lines placed, and imaging studies performed to detect thrombosis. These data were analyzed using descriptive analysis. Results There were 127 neonates born &lt;32 weeks gestation, all of whom were analyzed. Twenty-eight (35%) of neonates were born at &lt;27 weeks' gestation and twenty-two (17%) were &lt;1500 g at birth and were considered high risk infants. Seventy three percent of these patients were intubated at some point during their NICU admission. The majority of patients had bronchopulmonary dysplasia (63%). Ten patients developed necrotizing enterocolitis (7.8%), 28 had presumed or confirmed sepsis (22%), 52 had congenital heart disease (41%), and 12 had retinopathy of prematurity (9.4%). During the two-year period of this review, 60% of patients had at least one pRBC transfusion, 13% of patients had at least one platelet transfusion, and 6% of patients had at least one fresh frozen plasma (FFP) transfusion. A total of 35 platelet, 370 pRBC, and 11 FFP transfusions were administered with a mean total of 3.3 total transfusions per patient. The mean and median pre-transfusion platelet counts were 79,300/uL and 52,000/uL, respectively. The mean and median pre-transfusion hemoglobin values were 12.1 g/dL and 12.2 g/dL, respectively. Only two of 35 platelet transfusions were given after the publication of the PlaNeT2 study in January 2019; however, both transfusions were given for neonates with pre-transfusion platelet counts &gt;50,000/uL. There were no arterial or venous thrombosis events noted in our population even though 108 patients (85%) had a peripherally inserted central catheters for an average of 12 days, 32 (25%) had umbilical arterial catheters for an average of 7 days, and 66 (52%) had umbilical vein catheters placed for an average of 6 days. Conclusions The majority of transfusions given to neonates born at &lt;32 weeks gestation at the University of Arizona, Tucson institution over a two-year retrospective study period were pRBC transfusions with an incidence of 0.6 followed by platelet transfusions (incidence of 0.13) and FFP. Platelet transfusion practices changed drastically following publication of the PlaNet2 study, with only 2 of 35 (5.7%) platelet transfusions given after the publication of this study. No thrombotic events were documented in the study population despite a high prevalence of central venous lines and a mean pre-platelet transfusion threshold of 79,300/uL. Transfusion practice guidelines can affect clinical practices in the NICU and can potentially minimize risks. Larger prospective studies are needed to evaluate risk of thrombosis related to adult platelet transfusions given to neonates. Disclosures No relevant conflicts of interest to declare.

scholarly journals Cardiorespiratory coupling in preterm infants

2019 ◽  
Vol 126 (1) ◽  
pp. 202-213 ◽  
Author(s):  
Rohan Joshi ◽  
Deedee Kommers ◽  
Xi Long ◽  
Loe Feijs ◽  
Sabine Van Huffel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Heart Rate ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
The Other ◽  
Regulatory Mechanisms ◽  
Kangaroo Care ◽  
Cardiorespiratory Coupling

In preterm infants, a better understanding and quantification of cardiorespiratory coupling may help improve caregiving by enabling the tracking of maturational changes and subclinical signatures of disease. Therefore, in a study of 20 preterm infants admitted to a neonatal intensive care unit, we analyzed the cardiac and respiratory regulatory mechanisms as well as the coupling between them. In particular, we selectively analyzed coupling from changes in heart rate to respiratory oscillations as well as coupling from respiratory oscillations to the heart rate. Furthermore, we stratified this coupling based on decelerations and accelerations of the heart rate and by inspiration and expiration during respiration while contrasting periods of kangaroo care, an intervention known to enhance autonomic regulation, with periods in the incubator. We identified that preterm infants exhibit cardiorespiratory coupling that is nonsymmetric with regard to the direction of coupling. We demonstrate coupling from decelerations and accelerations of the heart rate to exhalation and inhalation, respectively, both on a beat-to-beat basis as well as with sustained decelerations and accelerations. On the other hand, on average, we also observed coupling from both inspiration and expiration to marginal decelerations in the heart rate. These phenomena, especially coupling from the changes in the heart rate to respiratory oscillations, were sensitive to whether the infant was receiving kangaroo care. NEW & NOTEWORTHY Preterm infants exhibit cardiorespiratory coupling that is nonsymmetric with regard to the direction of coupling; coupling from fluctuations in the heart rate to respiratory oscillations and vice versa are asymmetric. On average, coupling is observable from decelerations or accelerations in the heart rate to inhalation or exhalation, respectively, whereas, on average, both peaks and troughs of respiration exhibit coupling to marginal decelerations in the heart rate.

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