title: Precision of coherence analysis to detect cerebral autoregulation by near-infrared spectroscopy in preterm infants.
abstract: Coherence between spontaneous fluctuations in arterial blood pressure (ABP) and the cerebral near-infrared spectroscopy signal can detect cerebral autoregulation. Because reliable measurement depends on signals with high signal-to-noise ratio, we hypothesized that coherence is more precisely determined when fluctuations in ABP are large rather than small. Therefore, we investigated whether adjusting for variability in ABP (variability(ABP)) improves precision. We examined the impact of variability(ABP) within the power spectrum in each measurement and between repeated measurements in preterm infants. We also examined total monitoring time required to discriminate among infants with a simulation study. We studied 22 preterm infants (GA<30) yielding 215 10-min measurements. Surprisingly, adjusting for variability(ABP) within the power spectrum did not improve the precision. However, adjusting for the variability(ABP) among repeated measurements (i.e., weighting measurements with high variability(ABP) in favor of those with low) improved the precision. The evidence of drift in individual infants was weak. Minimum monitoring time needed to discriminate among infants was 1.3-3.7 h. Coherence analysis in low frequencies (0.04-0.1 Hz) had higher precision and statistically more power than in very low frequencies (0.003-0.04 Hz). In conclusion, a reliable detection of cerebral autoregulation takes hours and the precision is improved by adjusting for variability(ABP) between repeated measurements.
authors.affiliation: Copenhagen University Hospital - Rigshospitalet, Department of Neonatology, Blegdamsvej 9, Copenhagen, 2100 Denmark. gitte.holst.hahn@rh.regionh.dk
authors.forename: Gitte Holst
authors.initials: GH
authors.lastname: Hahn
authors.forename: Karl Bang
authors.initials: KB
authors.lastname: Christensen
authors.forename: Terence S
authors.initials: TS
authors.lastname: Leung
authors.forename: Gorm
authors.initials: G
authors.lastname: Greisen
mesh_terms: D000704:Analysis of Variance; D001794:Blood Pressure / Q000502:physiology; D002540:Cerebral Cortex / Q000502:physiology*; D005260:Female; D005583:Fourier Analysis; D006454:Hemoglobins / Q000737:chemistry; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D008297:Male; D010108:Oxyhemoglobins / Q000737:chemistry; D012680:Sensitivity and Specificity; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D013997:Time Factors
chemical_list: D006454:Hemoglobins; D010108:Oxyhemoglobins; C100003:deoxyhemoglobin