ST waveform analysis for monitoring hypoxic distress in fetal sheep after prolonged umbilical cord occlusion

Peter Andriessen, Alex Zwanenburg, Judith O.E.H. van Laar, Rik Vullings, Ben J.M. Hermans, Hendrik J. Niemarkt, Reint K. Jellema, Daan R.M.G. Ophelders, Tim G.A.M. Wolfs, Boris W. Kramer, Tammo Delhaas

Onderzoeksoutput: Bijdrage aan tijdschriftTijdschriftartikelAcademicpeer review

Uittreksel

Introduction The inconclusive clinical results for ST-waveform analysis (STAN) in detecting fetal hypoxemia may be caused by the signal processing of the STAN-device itself. We assessed the performance of a clinical STAN device in signal processing and in detecting hypoxemia in a fetal sheep model exposed to prolonged umbilical cord occlusion (UCO). Methods Eight fetal lambs were exposed to 25 minutes of UCO. ECG recordings were analyzed during a baseline period and during UCO. STAN-event rates and timing of episodic T/QRS rise, baseline T/QRS rise and the occurrence of biphasic ST-waveforms, as well as signal loss, were assessed. Results During baseline conditions of normoxemia, a median of 40 (IQR, 25–70) STAN-events per minute were detected, compared to 10 (IQR, 2–22) during UCO. During UCO STAN-events were detected in five subjects within 10 minutes and in six subjects after 18 minutes, respectively. Two subjects did not generate any STAN-event during UCO. Biphasic ST event rate was reduced during UCO (median 0, IQR 0–5), compared to baseline (median 32, IQR, 6–55). ST-waveforms could not be assessed in 62% of the recording time during UCO, despite a good quality of the ECG signal. Conclusions The STAN device showed limitations in detecting hypoxemia in fetal sheep after prolonged UCO. The STAN device produced high false positive event rates during baseline and did not detect T/QRS changes adequately after prolonged fetal hypoxemia. During 14% of baseline and 62% of the UCO period, the STAN-device could not process the ECG signal, despite its good quality. Resolving these issues may improve the clinical performance of the STAN device.

TaalEngels
Artikelnummere0195978
Aantal pagina's14
TijdschriftPLoS ONE
Volume13
Nummer van het tijdschrift4
DOI's
StatusGepubliceerd - 1 apr 2018

Vingerafdruk

Waveform analysis
Fetal Distress
umbilical cord
Umbilical Cord
distress
Sheep
sheep
Monitoring
monitoring
Equipment and Supplies
hypoxia
Electrocardiography
Signal processing
lambs

Citeer dit

Andriessen, Peter ; Zwanenburg, Alex ; van Laar, Judith O.E.H. ; Vullings, Rik ; Hermans, Ben J.M. ; Niemarkt, Hendrik J. ; Jellema, Reint K. ; Ophelders, Daan R.M.G. ; Wolfs, Tim G.A.M. ; Kramer, Boris W. ; Delhaas, Tammo. / ST waveform analysis for monitoring hypoxic distress in fetal sheep after prolonged umbilical cord occlusion. In: PLoS ONE. 2018 ; Vol. 13, Nr. 4.
@article{819b7729e1fd494a8f76f54a0f116369,
title = "ST waveform analysis for monitoring hypoxic distress in fetal sheep after prolonged umbilical cord occlusion",
abstract = "Introduction The inconclusive clinical results for ST-waveform analysis (STAN) in detecting fetal hypoxemia may be caused by the signal processing of the STAN-device itself. We assessed the performance of a clinical STAN device in signal processing and in detecting hypoxemia in a fetal sheep model exposed to prolonged umbilical cord occlusion (UCO). Methods Eight fetal lambs were exposed to 25 minutes of UCO. ECG recordings were analyzed during a baseline period and during UCO. STAN-event rates and timing of episodic T/QRS rise, baseline T/QRS rise and the occurrence of biphasic ST-waveforms, as well as signal loss, were assessed. Results During baseline conditions of normoxemia, a median of 40 (IQR, 25–70) STAN-events per minute were detected, compared to 10 (IQR, 2–22) during UCO. During UCO STAN-events were detected in five subjects within 10 minutes and in six subjects after 18 minutes, respectively. Two subjects did not generate any STAN-event during UCO. Biphasic ST event rate was reduced during UCO (median 0, IQR 0–5), compared to baseline (median 32, IQR, 6–55). ST-waveforms could not be assessed in 62{\%} of the recording time during UCO, despite a good quality of the ECG signal. Conclusions The STAN device showed limitations in detecting hypoxemia in fetal sheep after prolonged UCO. The STAN device produced high false positive event rates during baseline and did not detect T/QRS changes adequately after prolonged fetal hypoxemia. During 14{\%} of baseline and 62{\%} of the UCO period, the STAN-device could not process the ECG signal, despite its good quality. Resolving these issues may improve the clinical performance of the STAN device.",
author = "Peter Andriessen and Alex Zwanenburg and {van Laar}, {Judith O.E.H.} and Rik Vullings and Hermans, {Ben J.M.} and Niemarkt, {Hendrik J.} and Jellema, {Reint K.} and Ophelders, {Daan R.M.G.} and Wolfs, {Tim G.A.M.} and Kramer, {Boris W.} and Tammo Delhaas",
year = "2018",
month = "4",
day = "1",
doi = "10.1371/journal.pone.0195978",
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Andriessen, P, Zwanenburg, A, van Laar, JOEH, Vullings, R, Hermans, BJM, Niemarkt, HJ, Jellema, RK, Ophelders, DRMG, Wolfs, TGAM, Kramer, BW & Delhaas, T 2018, 'ST waveform analysis for monitoring hypoxic distress in fetal sheep after prolonged umbilical cord occlusion' PLoS ONE, vol. 13, nr. 4, e0195978. DOI: 10.1371/journal.pone.0195978

ST waveform analysis for monitoring hypoxic distress in fetal sheep after prolonged umbilical cord occlusion. / Andriessen, Peter; Zwanenburg, Alex; van Laar, Judith O.E.H.; Vullings, Rik; Hermans, Ben J.M.; Niemarkt, Hendrik J.; Jellema, Reint K.; Ophelders, Daan R.M.G.; Wolfs, Tim G.A.M.; Kramer, Boris W.; Delhaas, Tammo.

In: PLoS ONE, Vol. 13, Nr. 4, e0195978, 01.04.2018.

Onderzoeksoutput: Bijdrage aan tijdschriftTijdschriftartikelAcademicpeer review

TY - JOUR

T1 - ST waveform analysis for monitoring hypoxic distress in fetal sheep after prolonged umbilical cord occlusion

AU - Andriessen,Peter

AU - Zwanenburg,Alex

AU - van Laar,Judith O.E.H.

AU - Vullings,Rik

AU - Hermans,Ben J.M.

AU - Niemarkt,Hendrik J.

AU - Jellema,Reint K.

AU - Ophelders,Daan R.M.G.

AU - Wolfs,Tim G.A.M.

AU - Kramer,Boris W.

AU - Delhaas,Tammo

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Introduction The inconclusive clinical results for ST-waveform analysis (STAN) in detecting fetal hypoxemia may be caused by the signal processing of the STAN-device itself. We assessed the performance of a clinical STAN device in signal processing and in detecting hypoxemia in a fetal sheep model exposed to prolonged umbilical cord occlusion (UCO). Methods Eight fetal lambs were exposed to 25 minutes of UCO. ECG recordings were analyzed during a baseline period and during UCO. STAN-event rates and timing of episodic T/QRS rise, baseline T/QRS rise and the occurrence of biphasic ST-waveforms, as well as signal loss, were assessed. Results During baseline conditions of normoxemia, a median of 40 (IQR, 25–70) STAN-events per minute were detected, compared to 10 (IQR, 2–22) during UCO. During UCO STAN-events were detected in five subjects within 10 minutes and in six subjects after 18 minutes, respectively. Two subjects did not generate any STAN-event during UCO. Biphasic ST event rate was reduced during UCO (median 0, IQR 0–5), compared to baseline (median 32, IQR, 6–55). ST-waveforms could not be assessed in 62% of the recording time during UCO, despite a good quality of the ECG signal. Conclusions The STAN device showed limitations in detecting hypoxemia in fetal sheep after prolonged UCO. The STAN device produced high false positive event rates during baseline and did not detect T/QRS changes adequately after prolonged fetal hypoxemia. During 14% of baseline and 62% of the UCO period, the STAN-device could not process the ECG signal, despite its good quality. Resolving these issues may improve the clinical performance of the STAN device.

AB - Introduction The inconclusive clinical results for ST-waveform analysis (STAN) in detecting fetal hypoxemia may be caused by the signal processing of the STAN-device itself. We assessed the performance of a clinical STAN device in signal processing and in detecting hypoxemia in a fetal sheep model exposed to prolonged umbilical cord occlusion (UCO). Methods Eight fetal lambs were exposed to 25 minutes of UCO. ECG recordings were analyzed during a baseline period and during UCO. STAN-event rates and timing of episodic T/QRS rise, baseline T/QRS rise and the occurrence of biphasic ST-waveforms, as well as signal loss, were assessed. Results During baseline conditions of normoxemia, a median of 40 (IQR, 25–70) STAN-events per minute were detected, compared to 10 (IQR, 2–22) during UCO. During UCO STAN-events were detected in five subjects within 10 minutes and in six subjects after 18 minutes, respectively. Two subjects did not generate any STAN-event during UCO. Biphasic ST event rate was reduced during UCO (median 0, IQR 0–5), compared to baseline (median 32, IQR, 6–55). ST-waveforms could not be assessed in 62% of the recording time during UCO, despite a good quality of the ECG signal. Conclusions The STAN device showed limitations in detecting hypoxemia in fetal sheep after prolonged UCO. The STAN device produced high false positive event rates during baseline and did not detect T/QRS changes adequately after prolonged fetal hypoxemia. During 14% of baseline and 62% of the UCO period, the STAN-device could not process the ECG signal, despite its good quality. Resolving these issues may improve the clinical performance of the STAN device.

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Andriessen P, Zwanenburg A, van Laar JOEH, Vullings R, Hermans BJM, Niemarkt HJ et al. ST waveform analysis for monitoring hypoxic distress in fetal sheep after prolonged umbilical cord occlusion. PLoS ONE. 2018 apr 1;13(4). e0195978. Beschikbaar vanaf, DOI: 10.1371/journal.pone.0195978