RECAN Software Reliability Assessment for Heart Rate Variability (HRV) Analysis in a French Neonatal Intensive Care Unit (NICU) - EAP 2019 Congress and MasterCourse Porto Palacio Hotel

Thibault BLACHE ¹ Andrei Cividjian ⁵ Roxana Diehl ² Muriel Rabilloud ⁴ Olivier Claris ^1,2 Franck Plaisant ^1,2 Kim-An Nguyen ^1,2,3

¹Neonatalology, Hospices Civils de Lyon (HCL), Hôpital Femme Mère Enfant (HFME), France
²Neonatalology, Hospices Civils de Lyon (HCL), Centre Hospitalier Lyon Sud (CHLS), France
³Pharmacotoxicology, Hospices Civils de Lyon (HCL), France
⁴Biostatistic, Hospices Civils de Lyon (HCL), France
⁵Alpha 2 Society, Hospices Civils de Lyon (HCL), France

Background: Heart rate variability (HRV) consists of changes in the time intervals between consecutive heartbeats called interbeat intervals (IBIs). HRV constitutes a relevant noninvasive tool to assess the autonomic nervous system (ANS) function especially in preterm infants nearby their term corrected age. HRV would be a rational way to assess cardiovascular system maturation in this population. A stable and mature cardiovascular condition is essential before discharge of preterm infants. RECAN software were developed to precisely obtain the indices of HRV for routinely use by neonatologist. RECAN is based on an algorithm that reduces noises and artefacts from the 24h cardiac records and providing an automatic calculation for HRV indices.

Objective: To assess RECAN reliability in estimation of HRV indices comparing to the 24h Holter ECG interpreted by cardiologist.

Methods: We realised a prospective cohort study in a French NICU between 2015 and 2018. For any preterm newborn consecutively included, a holter ECG and RECAN were started at the same time during 24h. HRV indices were independently analysed by cardiologists and RECAN software. In this pilot study, we chose SDNN for the comparison. SDNN is one of heart rate variability time-domain indices. The standard deviation of the IBI of normal sinus beats (SDNN) is measured in ms. "Normal" means that abnormal beats, like ectopic beats (heartbeats that originate outside the right atrium’s sinoatrial node), have been removed.

Results: 30 correct 24h-records in 15 patients were included for analysis. For the primary result, the concordance correlation coefficient (CCC) in SDNN index was 0.94 (0.87 - 0.98; CI 95%), showing a strength of agreement, almost perfect.

Conclusion: RECAN is a reliable software for SDNN analysis compared to ECG-24h interpreted by cardiologist. Further research in large scale is necessary to validate this tool and its application in a secure discharge of preterm infants.