Continuous vital sign analysis for predicting and preventing neonatal diseases in the twenty-first century: big data to the forefront

Abstract

In the neonatal intensive care unit (NICU), heart rate, respiratory rate, and oxygen saturation are vital signs (VS) that are continuously monitored in infants, while blood pressure is often monitored continuously immediately after birth, or during critical illness. Although changes in VS can reflect infant physiology or circadian rhythms, persistent deviations in absolute values or complex changes in variability can indicate acute or chronic pathology. Recent studies demonstrate that analysis of continuous VS trends can predict sepsis, necrotizing enterocolitis, brain injury, bronchopulmonary dysplasia, cardiorespiratory decompensation, and mortality. Subtle changes in continuous VS patterns may not be discerned even by experienced clinicians reviewing spot VS data or VS trends captured in the monitor. In contrast, objective analysis of continuous VS data can improve neonatal outcomes by allowing heightened vigilance or preemptive interventions. In this review, we provide an overview of the studies that have used continuous analysis of single or multiple VS, their interactions, and combined VS and clinical analytic tools, to predict or detect neonatal pathophysiology. We make the case that big-data analytics are promising, and with continued improvements, can become a powerful tool to mitigate neonatal diseases in the twenty-first century.

Fig. 1

Physiologic and pathologic factors regulating vital signs. Diagram depicting how HR, BP, RR, and SpO2 are physiologically regulated in the preterm neonate, and patterns of vital signs changes that can be associated with pathophysiological states. HR heart rate, BP blood pressure, RR respiratory rate, SpO2 pulse oximetry

Fig. 2

Twenty-first century analytics of continuous vital sign data to prevent diseases in neonates. This illustration depicts a three-step approach combining: a single or multi-tier analytics of vital signs, b careful clinical assessment, and c auxiliary blood and other imaging studies to prevent and decrease morbidity from life-threatening illnesses. HeRo heart rate characteristics, HRC index heart rate characteristics index, POPS pulse oximetry predictive score, BP blood pressure, CBC complete blood count, CRP C-reactive protein, USG ultrasonography, ABG arterial blood gas, TCM transcutaneous carbon dioxide monitoring, NIRS near-infrared spectroscopy, EEG electroencephalogram, HUS head ultrasound, NEC necrotizing enterocolitis, BPD bronchopulmonary dysplasia, ROP retinopathy of prematurity, IVH intraventricular hemorrhage, MCA Doppler middle cerebral artery Doppler