Improving heart rate estimation in preterm infants with bivariate point process analysis of heart rate and respiration.

Accurate estimation of heart rate dynamics in preterm infants is important for predicting recurrent episodes of severe bradycardia. We hypothesize that estimation of heart rate can be improved by including respiration as a state variable, based on mechanisms that underlie cardio-respiratory coherence. For ten preterm infants, we demonstrate that including respiration as a covariate improves estimation accuracy by an average of 11% across bradycardia severity, and reduces the maximum error by 8%. We also find that cardio-respiratory coherence increases in low frequency content just prior to severe bradycardia. Thus, incorporating respiratory information may improve models of heart rate dynamics and narrow potential features for bradycardia prediction.