title: Features of Heart Rate Variability Capture Regulatory Changes During Kangaroo Care in Preterm Infants.
abstract: OBJECTIVE
  To determine whether heart rate variability (HRV) can serve as a surrogate measure to track regulatory changes during kangaroo care, a period of parental coregulation distinct from regulation within the incubator.
  
  
  METHODS
  Nurses annotated the starting and ending times of kangaroo care for 3 months. The pre-kangaroo care, during-kangaroo care, and post-kangaroo care data were retrieved in infants with at least 10 accurately annotated kangaroo care sessions. Eight HRV features (5 in the time domain and 3 in the frequency domain) were used to visually and statistically compare the pre-kangaroo care and during-kangaroo care periods. Two of these features, capturing the percentage of heart rate decelerations and the extent of heart rate decelerations, were newly developed for preterm infants.
  
  
  RESULTS
  A total of 191 kangaroo care sessions were investigated in 11 preterm infants. Despite clinically irrelevant changes in vital signs, 6 of the 8 HRV features (SD of normal-to-normal intervals, root mean square of the SD, percentage of consecutive normal-to-normal intervals that differ by >50 ms, SD of heart rate decelerations, high-frequency power, and low-frequency/high-frequency ratio) showed a visible and statistically significant difference (P <.01) between stable periods of kangaroo care and pre-kangaroo care. HRV was reduced during kangaroo care owing to a decrease in the extent of transient heart rate decelerations.
  
  
  CONCLUSIONS
  HRV-based features may be clinically useful for capturing the dynamic changes in autonomic regulation in response to kangaroo care and other changes in environment and state.
authors.affiliation: Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands; Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands.
authors.forename: Deedee R
authors.initials: DR
authors.lastname: Kommers
authors.affiliation: Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Clinical Physics, Máxima Medical Center, Veldhoven, The Netherlands. Electronic address: r.joshi@tue.nl.
authors.forename: Rohan
authors.initials: R
authors.lastname: Joshi
authors.affiliation: Department of Clinical Physics, Máxima Medical Center, Veldhoven, The Netherlands; Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands.
authors.forename: Carola
authors.initials: C
authors.lastname: van Pul
authors.affiliation: Patient Care and Measurements Department, Philips Research, Eindhoven, The Netherlands.
authors.forename: Louis
authors.initials: L
authors.lastname: Atallah
authors.affiliation: Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands.
authors.forename: Loe
authors.initials: L
authors.lastname: Feijs
authors.affiliation: Department of Gynecology, Máxima Medical Center, Veldhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
authors.forename: Guid
authors.initials: G
authors.lastname: Oei
authors.affiliation: Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands; Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands.
authors.forename: Sidarto
authors.initials: S
authors.lastname: Bambang Oetomo
authors.affiliation: Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands; Department of Pediatrics, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Andriessen
mesh_terms: D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D060127:Kangaroo-Mother Care Method / Q000379:methods*; D008297:Male
keywords: autonomic regulation; heart rate variability; kangaroo care; preterm infants