{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T15:47:09Z","timestamp":1791820029716,"version":"4.3.4"},"reference-count":35,"publisher":"IOP Publishing","issue":"9","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/iopscience.iop.org\/info\/page\/text-and-data-mining"}],"funder":[{"name":"NIH","award":["HD119199"],"award-info":[{"award-number":["HD119199"]}]},{"name":"Zickler Family Prenatal Pediatrics Institute"}],"content-domain":{"domain":["iopscience.iop.org"],"crossmark-restriction":false},"short-container-title":["Physiol. Meas."],"published-print":{"date-parts":[[2026,9,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Objective.<\/jats:italic>\n                    To validate previous findings that low heart rate variability (HRV) in the first week after birth is associated increased risk of cerebral palsy (CP). Additionally, to quantify the extent to which higher resolution beat-to-beat HRV metrics improve CP prediction and determine the effect of heartbeat averaging as done in bedside monitors.\n                    <jats:italic>Approach.<\/jats:italic>\n                    For infants &lt;29 weeks gestation at a level IV NICU, beat-to-beat heart rate (btbHR) and corresponding RR intervals (btbRR) from standard monitors were retrieved from a data repository. Monitor-displayed HR based on 12-beat averaging and measured at 1 Hz was also collected. The data were segmented into 10 min windows, and multiple HRV metrics were calculated including standard deviation (SD), low- and high-frequency HRV (LF, HF) and normalized low- and high-frequency HRV. Additionally, detrended fluctuation analysis (DFA) slope (alpha) and root mean square (RMS) metrics were calculated for both short (alpha1, RMS1) and long range (alpha2, RMS2) fractal scaling exponents. Metrics were averaged over the first week after birth for each infant to provide representative values that were used to quantify CP prediction performance using the area under the receiver operating characteristic curve (AUC).\n                    <jats:italic>Main Results.<\/jats:italic>\n                    This study included 102 infants,11 (10.8%) with CP. The SD of the 1 Hz monitor HR had AUC 0.754 compared to the highest values of 0.769 and 0.764 for DFA RMS1 and RMS2. Since raw btbHR contains erroneous beats, averaging generally improves performance. With averaging over 12 beats, as is done by most bedside monitors, RMS2 of btbHR and LF of btbRR had highest AUCs of 0.764 and 0.771 respectively.\n                    <jats:italic>Significance.<\/jats:italic>\n                    We externally validated that, in preterm infants during the first week after birth, reduced HRV predicts subsequent diagnosis of CP. Measures calculated from btbHR data showed slightly superior performance compared with 1 Hz heart rate data displayed on standard NICU bedside monitors.\n                  <\/jats:p>","DOI":"10.1088\/1361-6579\/aea9e9","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T22:53:47Z","timestamp":1789772027000},"page":"095012","update-policy":"https:\/\/doi.org\/10.1088\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prediction of cerebral palsy in extremely preterm infants with beat-to-beat and lower-resolution heart rate variability metrics"],"prefix":"10.1088","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9149-332X","authenticated-orcid":true,"given":"R B","family":"Govindan","sequence":"first","affiliation":[{"name":"The Zickler Family Prenatal Pediatrics Institute"},{"name":"The Developing Brain Institute, Children\u2019s National Hospital"},{"name":"The George Washington University School of Medicine and Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Venkata Chaitanya","family":"Chirumamilla","sequence":"additional","affiliation":[{"name":"The Zickler Family Prenatal Pediatrics Institute"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Lisa","family":"Letzkus","sequence":"additional","affiliation":[{"name":"University of Virginia School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Adre","family":"du Plessis","sequence":"additional","affiliation":[{"name":"The Zickler Family Prenatal Pediatrics Institute"},{"name":"The Developing Brain Institute, Children\u2019s National Hospital"},{"name":"The George Washington University School of Medicine and Health Sciences"},{"name":"The George Washington University School of Medicine and Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1081-8741","authenticated-orcid":true,"given":"Karen D","family":"Fairchild","sequence":"additional","affiliation":[{"name":"University of Virginia School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6259-4850","authenticated-orcid":true,"given":"Douglas E","family":"Lake","sequence":"additional","affiliation":[{"name":"University of Virginia School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"266","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"pmeaaea9e9bib1","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1126\/science.6166045","type":"journal-article","article-title":"Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control","volume":"213","author":"Akselrod","year":"1981","journal-title":"Science"},{"key":"pmeaaea9e9bib2","doi-asserted-by":"publisher","first-page":"939","DOI":"10.1203\/01.PDR.0000145257.75072.BB","type":"journal-article","article-title":"Cardiovascular autonomic regulation in preterm infants: the effect of atropine","volume":"56","author":"Andriessen","year":"2004","journal-title":"Pediatr. Res."},{"key":"pmeaaea9e9bib3","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1209\/epl\/i2001-00208-x","type":"journal-article","article-title":"Scale-specific and scale-independent measures of heart rate variability as risk indicators","volume":"53","author":"Ashkenazy","year":"2001","journal-title":"EPL (Europhys. Lett.)"},{"key":"pmeaaea9e9bib4","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3233\/NPM-230093","type":"journal-article","article-title":"Heart rate and oxygen saturation patterns in very low birth weight infants with early onset sepsis and histologic chorioamnionitis","volume":"17","author":"Bultmann","year":"2024","journal-title":"J. Neonatal Perinatal Med."},{"key":"pmeaaea9e9bib5","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2020.561186","type":"journal-article","article-title":"Heart rate variability in the perinatal period: a critical and conceptual review","volume":"14","author":"Chiera","year":"2020","journal-title":"Front. Neurosci."},{"key":"pmeaaea9e9bib6","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1007\/s00431-025-06738-w","type":"journal-article","article-title":"Intrapartum recognition and management of fetal inflammation","volume":"185","author":"Di Pasquo","year":"2026","journal-title":"Eur. J. Pediatr."},{"key":"pmeaaea9e9bib7","doi-asserted-by":"publisher","first-page":"832","DOI":"10.1111\/nmo.12337","type":"journal-article","article-title":"Diminished vagal tone is a predictive biomarker of necrotizing enterocolitis-risk in preterm infants","volume":"26","author":"Doheny","year":"2014","journal-title":"Neurogastroenterol. Motil."},{"key":"pmeaaea9e9bib8","doi-asserted-by":"publisher","first-page":"R1019","DOI":"10.1152\/ajpregu.00132.2009","type":"journal-article","article-title":"Endotoxin depresses heart rate variability in mice: cytokine and steroid effects","volume":"297","author":"Fairchild","year":"2009","journal-title":"Am. J. Physiol. Regul. Integr. Comp. Physiol."},{"key":"pmeaaea9e9bib9","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1016\/j.cels.2017.10.001","type":"journal-article","article-title":"Hctsa: a computational framework for automated time-series phenotyping using massive feature extraction","volume":"5","author":"Fulcher","year":"2017","journal-title":"Cell Syst."},{"key":"pmeaaea9e9bib10","doi-asserted-by":"publisher","DOI":"10.1098\/rsif.2013.0048","type":"journal-article","article-title":"Highly comparative time-series analysis: the empirical structure of time series and their methods","volume":"10","author":"Fulcher","year":"2013","journal-title":"J. R. Soc. Interface"},{"key":"pmeaaea9e9bib11","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1038\/pr.2015.28","type":"journal-article","article-title":"Heart rate variability in hypoxic ischaemic encephalopathy: correlation with EEG grade and two-year neurodevelopmental outcome","volume":"77","author":"Goulding","year":"2015","journal-title":"Pediatr. Res."},{"key":"pmeaaea9e9bib12","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2024.101544","type":"journal-article","article-title":"Bedside monitoring tools and advanced signal processing approaches to monitor critically-ill infants","volume":"29","author":"Govindan","year":"2024","journal-title":"Semin. Fetal Neonatal Med."},{"key":"pmeaaea9e9bib13","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1111\/j.1540-8167.1994.tb01151.x","type":"journal-article","article-title":"The dynamic range of neonatal heart rate variability","volume":"5","author":"Griffin","year":"1994","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"pmeaaea9e9bib14","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1159\/000014209","type":"journal-article","article-title":"Heart rate variability in preterm brain-injured and very-low-birth-weight infants","volume":"77","author":"Hanna","year":"2000","journal-title":"Biol. Neonate"},{"key":"pmeaaea9e9bib15","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.pediatrneurol.2018.07.002","type":"journal-article","article-title":"Hammersmith infant neurological examination asymmetry score distinguishes hemiplegic cerebral palsy from typical development","volume":"87","author":"Group N C H E D","year":"2018","journal-title":"Pediatr. Neurol."},{"key":"pmeaaea9e9bib16","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.628075","type":"journal-article","article-title":"The role of neuroimaging and genetic analysis in the diagnosis of children with cerebral palsy","volume":"11","author":"Horber","year":"2020","journal-title":"Front. Neurol."},{"key":"pmeaaea9e9bib17","doi-asserted-by":"publisher","first-page":"7691","DOI":"10.1038\/s41598-019-44209-z","type":"journal-article","article-title":"Statistical modeling of heart rate variability to unravel the factors affecting autonomic regulation in preterm infants","volume":"9","author":"Joshi","year":"2019","journal-title":"Sci. Rep."},{"key":"pmeaaea9e9bib18","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1038\/sj.jp.7211492","type":"journal-article","article-title":"Hypercapnia during the first 3 days of life is associated with severe intraventricular hemorrhage in very low birth weight infants","volume":"26","author":"Kaiser","year":"2006","journal-title":"J. Perinatol."},{"key":"pmeaaea9e9bib19","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1016\/S0378-4371(01)00144-3","type":"journal-article","article-title":"Detecting long-range correlations with detrended fluctuation analysis","volume":"295","author":"Kantelhardt","year":"2001","journal-title":"Physica A"},{"key":"pmeaaea9e9bib20","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1038\/s41390-019-0527-0","type":"journal-article","article-title":"Continuous vital sign analysis for predicting and preventing neonatal diseases in the twenty-first century: big data to the forefront","volume":"87","author":"Kumar","year":"2020","journal-title":"Pediatr. Res."},{"key":"pmeaaea9e9bib21","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-055209","type":"journal-article","article-title":"Neonatal heart rate variability: a contemporary scoping review of analysis methods and clinical applications","volume":"11","author":"Latremouille","year":"2021","journal-title":"BMJ Open"},{"key":"pmeaaea9e9bib22","doi-asserted-by":"publisher","first-page":"e528","DOI":"10.1055\/s-0042-1756335","type":"journal-article","article-title":"Heart rate and pulse oximetry dynamics in the first week after birth in neonatal intensive care unit patients and the risk of cerebral palsy","volume":"41","author":"Letzkus","year":"2024","journal-title":"Am. J. Perinatol."},{"key":"pmeaaea9e9bib23","doi-asserted-by":"publisher","first-page":"1040","DOI":"10.1038\/s41390-023-02853-2","type":"journal-article","article-title":"Heart rate patterns predicting cerebral palsy in preterm infants","volume":"97","author":"Letzkus","year":"2025","journal-title":"Pediatr. Res."},{"key":"pmeaaea9e9bib24","doi-asserted-by":"publisher","first-page":"1860","DOI":"10.1038\/s41390-023-02775-z","type":"journal-article","article-title":"Neonatal encephalopathy and hypoxic-ischemic encephalopathy: moving from controversy to consensus definitions and subclassification","volume":"94","author":"Steering Group for D","year":"2023","journal-title":"Pediatr. Res."},{"key":"pmeaaea9e9bib25","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1001\/jamapediatrics.2021.0878","type":"journal-article","article-title":"Early intervention for children aged 0\u20132 years with or at high risk of cerebral palsy: international clinical practice guideline based on systematic reviews","volume":"175","author":"Morgan","year":"2021","journal-title":"JAMA Pediatr."},{"key":"pmeaaea9e9bib26","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1111\/jpc.12995","type":"journal-article","article-title":"Sensitivity and specificity of general movements assessment for diagnostic accuracy of detecting cerebral palsy early in an Australian context","volume":"52","author":"Morgan","year":"2016","journal-title":"J. Paediatr. Child Health"},{"key":"pmeaaea9e9bib27","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1001\/jamapediatrics.2017.1689","type":"journal-article","article-title":"Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment","volume":"171","author":"Novak","year":"2017","journal-title":"JAMA Pediatr."},{"key":"pmeaaea9e9bib28","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2022.860145","type":"journal-article","article-title":"Heart rate variability analysis to evaluate autonomic nervous system maturation in neonates: an expert opinion","volume":"10","author":"Patural","year":"2022","journal-title":"Front. Pediatr."},{"key":"pmeaaea9e9bib29","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1063\/1.166141","type":"journal-article","article-title":"Quantification of scaling exponents and crossover phenomena in nonstationary heartbeat time series","volume":"5","author":"Peng","year":"1995","journal-title":"Chaos"},{"key":"pmeaaea9e9bib30","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1038\/s41390-021-01420-x","type":"journal-article","article-title":"Autonomic development in preterm infants is associated with morbidity of prematurity","volume":"91","author":"Schlatterer","year":"2022","journal-title":"Pediatr. Res."},{"key":"pmeaaea9e9bib31","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmpb.2019.104996","type":"journal-article","article-title":"Prediction of short-term health outcomes in preterm neonates from heart-rate variability and blood pressure using boosted decision trees","volume":"180","author":"Semenova","year":"2019","journal-title":"Comput. Methods Programs Biomed."},{"key":"pmeaaea9e9bib32","doi-asserted-by":"publisher","first-page":"1823","DOI":"10.1038\/s41390-024-03606-5","type":"journal-article","article-title":"Using heart rate variability to predict neurological outcomes in preterm infants: a scoping review","volume":"97","author":"Smolkova","year":"2025a","journal-title":"Pediatr. Res."},{"key":"pmeaaea9e9bib33","doi-asserted-by":"publisher","DOI":"10.1038\/s41390-025-04632-7","type":"journal-article","article-title":"Reduced heart rate variability predicts severe intraventricular haemorrhage in extremely preterm infants","author":"Smolkova","year":"2025b","journal-title":"Pediatr. Res."},{"key":"pmeaaea9e9bib34","doi-asserted-by":"publisher","first-page":"810","DOI":"10.1542\/peds.2008-0253","type":"journal-article","article-title":"Altered heart rhythm dynamics in very low birth weight infants with impending intraventricular hemorrhage","volume":"123","author":"Tuzcu","year":"2009","journal-title":"Pediatrics"},{"key":"pmeaaea9e9bib35","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1203\/01.pdr.0000196738.03171.f1","type":"journal-article","article-title":"Variability in cerebral oxygen delivery is reduced in premature neonates exposed to chorioamnionitis","volume":"59","author":"Yanowitz","year":"2006","journal-title":"Pediatr. Res."}],"container-title":["Physiological Measurement"],"original-title":[],"link":[{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6579\/aea9e9","content-type":"text\/html","content-version":"am","intended-application":"text-mining"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6579\/aea9e9\/pdf","content-type":"application\/pdf","content-version":"am","intended-application":"text-mining"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6579\/aea9e9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6579\/aea9e9\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6579\/aea9e9\/pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6579\/aea9e9\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6579\/aea9e9\/pdf","content-type":"application\/pdf","content-version":"am","intended-application":"similarity-checking"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6579\/aea9e9\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T14:56:06Z","timestamp":1791816966000},"score":1,"resource":{"primary":{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6579\/aea9e9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":35,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,30]]},"published-print":{"date-parts":[[2026,9,30]]}},"URL":"https:\/\/doi.org\/10.1088\/1361-6579\/aea9e9","relation":{},"ISSN":["0967-3334","1361-6579"],"issn-type":[{"value":"0967-3334","type":"print"},{"value":"1361-6579","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"assertion":[{"value":"Prediction of cerebral palsy in extremely preterm infants with beat-to-beat and lower-resolution heart rate variability metrics","name":"article_title","label":"Article Title"},{"value":"Physiological Measurement","name":"journal_title","label":"Journal Title"},{"value":"paper","name":"article_type","label":"Article Type"},{"value":"\u00a9 2026 The Author(s). Published on behalf of Institute of Physics and Engineering in Medicine by IOP Publishing Ltd","name":"copyright_information","label":"Copyright Information"},{"value":"2026-06-09","name":"date_received","label":"Date Received","group":{"name":"publication_dates","label":"Publication dates"}},{"value":"2026-09-18","name":"date_accepted","label":"Date Accepted","group":{"name":"publication_dates","label":"Publication dates"}},{"value":"2026-09-30","name":"date_epub","label":"Online publication date","group":{"name":"publication_dates","label":"Publication dates"}}]}}