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Abstract and Figures

Background: Low vagal tone (VT) is a marker of vulnerability to stress and the risk of developing necrotizing enterocolitis in preterm infants. Electric fields produced by equipment in the neonatal intensive care unit (NICU) induce an electric potential measurable on the skin in reference to ground. An electrical connection to ground reduces the skin potential and improves VT in adults. Objectives: We aimed to measure the electric field strengths in the NICU environment and to determine if connecting an infant to electrical ground would reduce the skin potential and improve VT. We also wished to determine if the skin potential correlated with VT. Methods: Environmental magnetic flux density (MFD) was measured in and around incubators. Electrical grounding (EG) was achieved with a patch electrode and wire that extended to a ground outlet. We measured the skin potential in 26 infants and heart rate variability in 20 infants before, during, and after grounding. VT was represented by the high-frequency power of heart rate variability. Results: The background MFD in the NICU was below 0.5 mG, but it ranged between 1.5 and 12.7 mG in the closed incubator. A 60-Hz oscillating potential was recorded on the skin of all infants. With EG, the skin voltage dropped by about 95%. Pre-grounding VT was inversely correlated with the skin potential. VT increased by 67% with EG. After grounding, the VT fell to the pre-grounding level. Conclusion: The electrical environment affects autonomic balance. EG improves VT and may improve resilience to stress and lower the risk of neonatal morbidity in preterm infants.
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Original Paper
Neonatology 2017;112:187–192
DOI: 10.1159/000475744
Electrical Grounding Improves Vagal
Tone in Preterm Infants
RohitPassi a KimK.Doheny a YuriGordin b HansHinssen c CharlesPalmer a
a Division of Newborn Medicine, PennState Health Children’s Hospital, and
b College of Medicine and
c Department
of Clinical Engineering, College of Medicine, Pennsylvania State University, Hershey, PA , USA
12.7 mG in the closed incubator. A 60-Hz oscillating potential
was recorded on the skin of all infants. With EG, the skin volt-
age dropped by about 95%. Pre-grounding VT was inversely
correlated with the skin potential. VT increased by 67% with
EG. After grounding, the VT fell to the pre-grounding level.
Conclusion: The electrical environment affects autonomic
balance. EG improves VT and may improve resilience to
stress and lower the risk of neonatal morbidity in preterm
infants. © 2017 S. Karger AG, Basel
Introduction
Equipment in the neonatal intensive care unit (NICU)
generates electric fields. The 50- to 60-Hz alternating cur-
rent that powers incubators produces extremely-low-fre-
quency electromagnetic fields (ELF-EMFs). The magnet-
ic part of the field within the incubator is between 2 and
100 mG
[1–3] . Magnetic fields as low as 2 mG have been
shown to produce biological effects on fetuses
[4, 5] and
on cells in culture
[6] , raising the possibility that these
fields may adversely affect the preterm infant.
Bellieni et al. [7] found that vagal tone (VT) in preterm
infants reversibly increased when the incubator power
Keywords
Electromagnetic fields · Vagal tone · Electrical grounding ·
Heart rate variability
Abstract
Background: Low vagal tone (VT) is a marker of vulnerability
to stress and the risk of developing necrotizing enterocolitis
in preterm infants. Electric fields produced by equipment in
the neonatal intensive care unit (NICU) induce an electric po-
tential measurable on the skin in reference to ground. An
electrical connection to ground reduces the skin potential
and improves VT in adults. Objectives: We aimed to measure
the electric field strengths in the NICU environment and to
determine if connecting an infant to electrical ground would
reduce the skin potential and improve VT. We also wished to
determine if the skin potential correlated with VT. Methods:
Environmental magnetic flux density (MFD) was measured
in and around incubators. Electrical grounding (EG) was
achieved with a patch electrode and wire that extended to a
ground outlet. We measured the skin potential in 26 infants
and heart rate variability in 20 infants before, during, and af-
ter grounding. VT was represented by the high-frequency
power of heart rate variability. Results: The background MFD
in the NICU was below 0.5 mG, but it ranged between 1.5 and
Received: February 27, 2017
Accepted after revision: April 13, 2017
Published online: June 10, 2017
Charles Palmer, MB, ChB
Division of Newborn Medicine, PennState Health Children’s Hospital
500 University Drive, PO Box 850
Hershey, PA 17033 (USA)
E-Mail cpalmer @ psu.edu
© 2017 S. Karger AG, Basel
www.karger.com/neo
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DOI: 10.1159/000475744
188
was switched off [7] . VT is a measure of resilience and
homeostasis
[8] . Low VT may also be associated with an
increased risk of developing necrotizing enterocolitis
(NEC)
[9] .
When a human body is exposed to alternating 60-Hz
ELF-EMFs, a voltage is induced on the skin surface. How-
ever, when the body is conductively connected to electri-
cal ground, this skin potential is dissipated
[10] . Studies
in adults found that electrical grounding (EG) produces
an increase in VT
[11, 12] .
The primary objective of this study was to determine
if the VT of preterm infants in a NICU can be increased
by EG. We also wished to measure the magnetic flux den-
sity (MFD) within the NICU environment and determine
if the skin potential correlated with VT.
Methods
Subjects and Samples
This study was conducted in the NICU at the PennState Health
Hershey Medical Center from October 2012 to January 2014. The
IRB of the Penn State College of Medicine approved the study. The
study design was a prospective observational one, using a within-
subjects cross-over approach. We included 26 neonates who were
born AGA (appropriately grown for gestational age) and who were
26–36 weeks of postmenstrual age and 6–60 days of age hospital-
ized in the NICU at the PennState Health Hershey Medical Center.
We excluded neonates who were medically unstable, on mechani-
cal ventilation, or born with any severe congenital anomaly or car-
diac rhythm disturbance, as these conditions are known to impact
autonomic system measurement.
Seventeen patients were initially studied for skin voltage in
closed incubators with the power turned on, and 9 in open cribs.
Heart rate variability (HRV) data, however, were obtained on 13
infants in closed incubators and on 7 infants in open cribs.
Measurement of ELF-EMFs
Two empty thermoregulatory units used in the NICU were as-
sessed for MFD only: a closed incubator (Ohmeda Giraffe Omni-
Bed) with the power turned on, and a radiant infant warmer
(Ohmeda Ohio Infant Warmer). Additionally, ELF-EMFs emitted
from a popular humidifier model, used in conjunction with closed
incubator systems, were analyzed. MFD was measured using the
Emdex II Gauss Meter (Enertech Consultants, Campbell, CA,
USA). The EMF from each incubator was measured in isolation,
in a room separate from the NICU environment, without addi-
tional AC-powered equipment in proximity. The equipment was
plugged into an electrical outlet and left in “standby” mode (pow-
er on). The background MFD was recorded prior to each measure-
ment, with a baseline of 0.3–0.5 mG found evenly distributed
throughout the plane of the mattress. At 3-inch increments in both
length and width across the mattress surface, the Emdex II meter
was used to collect the instantaneous MFD. This instrument was
consistently oriented with the display panel in the same direction
relative to the incubator while all readings were recorded. A total
of 51 points were measured on the oval-shaped surface of the stan-
dard incubator mattress; 80 points were measured along the rect-
angular surface of the mattress in the infant warmer. Three-di-
mensional representations of the ELF-EMF distributions on the
mattresses were generated from these data. We also measured the
background MFD in the NICU.
Study Procedure
The skin potential was measured with a voltmeter (Fluke 725
US Multifunction Process Calibrator) which was connected to the
infant’s skin and to the dedicated ground socket in the bedside
console. We measured the voltage for the first 6 patients with the
voltmeter; then, for the next 20 patients, we changed to measuring
continuously using a Bioamplifier (Bio Amp Model FE132; ADIn-
struments, Bella Vista, NSW, Australia) connected to a data acqui-
sition system (Powerlab 16/30 ML 880; ADInstruments) that re-
corded the signal at 1,000 Hz so that the oscillating potential could
be recorded (LabChart version 7; ADInstruments). We display the
results in millivolts. Changes in skin voltage potential were direct-
ly recorded upon connection and disconnection from ground in
real time. An average of 4 measurements was conducted to calcu-
late the mean skin voltage in the pre-grounding and grounding
phases.
Grounding
To achieve grounding, we used a commercially available patch
electrode (Earthing.Com Inc., Thousand Palms, CA, USA) that
had a 100-kΩ resistor built into the snap connector which was con-
nected to the patch on the patient’s skin. The resistor provided a
safety feature in the unlikely event the infant were exposed to a live
electric current. Importantly, the ground outlet was a separate,
dedicated outlet on the console at the bedside and had no electrical
connection to the power outlets. We reversibly connected the pa-
tient to ground by connecting the wire to the ground outlet with-
out handling the baby.
To measure the effect of EG on HRV, the EKG signal from the
infant’s bedside monitor was digitally captured on the data acqui-
sition system (PowerLab 7) for a duration of 20–40 min while stan-
dardizing for the time of day, environmental stimuli, and post-
feeding behavioral state. HRV was calculated for each patient by
averaging the results of repeated 2-min recordings during epochs
which represented the time before, during, and after EG (pre-
grounding, grounding, and post-grounding phases). EG was dis-
continued by removal of the wire from the ground outlet without
handling the infant. For each epoch of sampling, spectral analysis
of HRV was used to determine the HRV parameters.
Heart Rate Variability
Electrocardiographic R-wave data were obtained by the data
acquisition system at a sampling frequency of 1 kHz, and stored
for later spectral HRV analysis using the PowerLab 7 HRV module.
We selected 2-min segments which we manually reviewed to be
free of ectopic beats and artifacts for analysis, then averaged the
analyses of the epochs for each infant ( n = 4 segments per infant
per phase, i.e., pre-grounding, grounding, and post-grounding).
We only measured the low-frequency (LF, indicative of both VT
and sympathetic tone) and high-frequency (HF, indicative of VT)
components and total power, as the fast Fourier transform of the
beat-to-beat intervals used to calculate the frequency measures
above is known to have a limited accuracy for power estimation in
the very-low-frequency range with segments of duration below
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Electrical Grounding Improves Vagal
Tone
Neonatology 2017;112:187–192
DOI: 10.1159/000475744
189
5 min [13] . The 0.03- to 0.29-Hz frequency bandwidth was used
for measurement of the LF domain and the 0.3- to 1.3-Hz band-
width was used to calculate the HF domain, as it is reflective of the
effect of respirations on the heart rate. To calculate the HF band-
width, we used the mean ± 2 SD of the spontaneous resting breath
rates (20–80 breaths/min)
[9] . VT (measured by HF HRV) slows
the heart rate during exhalation and prolongs the beat-to-beat in-
terval. The total power spectrum was calculated as the sum of HF
+ LF, as a measure of overall HRV. To estimate sympathovagal
balance, the LF/HF ratio was calculated. The SD of all normal R-R
intervals (SDNN) was used as a measure of time domain analysis
of HRV as it expresses beat to beat variability. Thus SDNN is an
indicator of general HRV and has been used widely in adult studies
as marker of cardiovascular and autonomic well-being
[14] . HF
power is a marker of parasympathetic tone and LF power is a mea-
sure of both sympathetic and parasympathetic tone
[14] .
Statistical Analysis
Statistical analysis was performed using IBM-SPSS version 24
(SPSS Inc., Armonk, NY, USA). Descriptive statistics were com-
puted for key variables and checked for outliers and normality.
Data are expressed as mean ± SE (or SD) and analyzed with t tests
and repeated-measures ANOVAs to compare continuous vari-
ables. All tests were two-tailed at a 5% significance level. Due to
skewness of the data on tests of normality, HF and LF, SDNN, and
heart rate data were transformed using natural log prior to per-
forming repeated-measures ANOVAs or t tests.
Results
The subjects included 26 stable preterm infants with a
gestational age of 30.35 ± 2.68 weeks (mean ± SD) and a
birth weight of 1,476 ± 488 g ( Table1 ). Complete HRV
data were available for 20 subjects; on 6 subjects there
were only skin voltage data.
The MFD measured within the closed neonatal incu-
bator in our unit (Ohmeda Giraffe OmniBed) ranged
from 1.5 to 12.7 mG, with a mean of 4.0 (±2.8) mG. A
higher MFD was detected at the end of the mattress,
where the power supply and control panel are located
( Fig.1 ). The MFD at the mattress level from the radiant
infant warmer (Ohmeda Ohio Care Plus) was 0.8–1.7
mG, with a mean of 1.1 (±0.02) mG. Unlike in the closed
incubator, there was no appreciable difference in flux
across the mattress surface in the radiant infant warmer.
The MFD measured outside and surrounding the
closed incubator in standby mode adjacent to the control
panel was approximately 280 mG, with the highest values
near the control panel 2 feet above the floor, at the level
of the AC power source. Values above 2 mG were seen up
to 2 feet away. The humidifier emitted more than 390 mG
adjacent to its rear panel, and values exceeding 2 mG were
measured up to 18 inches away. The fields from our trans-
port incubator (Airborne 750i) were nearly 10-fold high-
er than within the closed incubator: the MFD ranged
from 3.6 to 151.8 mG. The background levels were 0.3–
0.5 mG.
We recorded a 60-Hz alternating skin voltage on all
babies. The skin voltage dropped the instant the patient
was connected to ground ( Fig.2 ). The skin voltage in the
pre-grounding phase was 415.3 ± 277.5 mV (mean ± SD)
and dropped by more than 95% during the grounding
phase to 19.1 ± 16.8 mV ( Table2 ). Seventeen infants were
placed in a closed incubator with the power on, and 9 in-
fants were placed in an open crib, at the time of the ex-
Table 1. Characteristics of the infant sample (n = 26)
Variable Min. Max. Mean SE
GA at birth, weeks 24.2 34.2 30.3 0.5
DOL on experiment day 5 68 22.5 3.2
Adjusted GA on experiment day 31.4 35.5 33.5 0.2
Birth weight, g 470 2,352 1,476.2 95.8
Weight on experiment day, g 955 2,241 1,721.3 51.3
GA, gestational age; DOL, day of life.
25 inches
18.75 inches
14
12
10
8
6
4
2
0
mG
Fig. 1. The columns represent the magnetic flux density (MFD)
within the standard incubator measured at the mattress level. The
MFD ranged between 1.5 and 12.7 mG. The field strength was
highest above the power supply and near the control panel.
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periment. The skin voltage on the 17 infants in the closed
incubators during the pre-grounding phase was 483 ± 306
mV, compared to 288 ± 159 mV (mean ± SD) on the 9
infants in the open crib ( p = 0.09). Interestingly, there was
a significant inverse correlation between the skin poten-
tial and HF power in the pre-grounding phase ( R = 0.47,
p = 0.04). Accordingly, higher skin voltage was associated
with lower VT.
The HF power for the 20 subjects increased by 67%
when they were connected to ground ( Table3 ). The HF
power was 6.59 ms
2 in the pre-grounding phase; it in-
creased to 11.00 ms
2 upon grounding ( p = 0.003) and de-
creased to 6.14 ms
2 upon discontinuation of grounding
( p = 0.02) (repeated-measures ANOVA).
Grounding produced a significant increase in LF pow-
er ( p = 0.01), which fell again in the post-grounding phase.
The LF/HF ratio did not change significantly during
grounding. The SDNN and heart rate also did not change
significantly with grounding ( Table3 ).
We compared the effect of the thermoregulatory envi-
ronment on the HRV parameters before, during, and af-
50
mV
50
–50
1 s
Fig. 2. Recording of skin surface potential. A 1-s interval is shown.
The field alternates at 60 Hz. At the onset of electrical grounding
(arrow), the voltage diminished immediately. The mean decrease
in voltage ± SE was 95.6 ± 1.1% ( p < 0.001, paired sample t test).
Table 2. Changes in skin potential (mV) with electrical grounding
Min. Max. Mean SE
Pre-grounding phase 38.92 1,414.40 415.29 54.4
Grounding phase 0.94 72.05 19.06 3.3
Twenty-six patients were tested before grounding and again
after grounding. Connecting patients to electrical ground pro-
duced a >95% drop in skin potential.
Table 3. Heart rate variability changes with electrical grounding
Variable Before
grounding
Grounding After
grounding
Total power, ms281.2 (36.59) 126.2 (37.48) 69.6 (12.18)
HF power, ms26.6 (1.8) 11.0 (3.1)*6.2 (1.2)**
LF power, ms274.6 (34.9) 115.3 (34.6)§63.4 (11.5)
LF/HF ratio 11.3 (2.0) 11.69 (1.8) 12.5 (2.2)
SDNN, ms 11.0 (1.7) 12.8 (1.3) 11.7 (1.1)
Heart rate, bpm 158.51 (2.4) 157.0 (2.5) 157.6 (2.3)
Values are expressed as mean (SE); n = 20. Repeated-measures
ANOVA with Bonferroni correction was performed on the natural
log of the raw values shown in the table for HF power, LF power,
SDNN, and heart rate. * p = 0.003, repeated-measures ANOVA
before grounding vs. grounding; ** p = 0.02 grounding vs. after
grounding; § p = 0.01 before grounding vs. grounding. Vagal tone
was measured by HF power in ms2. HF, high-frequency; LF, low-
frequency; SDNN, standard deviation of all normal R-R (NN) in-
tervals.
Color version available online
Table 4. Comparison of HRV parameters between thermoregula-
tory units
HRV parameter Open crib
(n = 7)
Closed incubator
(n = 13)
p
LF power, ms2
Before grounding 161 (94) 27.9 (7) 0.003
Grounding 192 (91) 74.1 (17) 0.12
After grounding 102 (24) 42.4 (8.1) 0.036
HF power, ms2
Before grounding 10.2 (4.8) 4.6 (0.9) 0.19
Grounding 16.0 (8.6) 8.2 (1.4) 0.5
After grounding 7.8 (3.0) 5.3 (0.8) 0.56
SDNN, ms
Before grounding 17.3 (3.4) 7.6 (1) 0.001
Grounding 15.7 (2.8) 11.2 (1.1) 0.12
After grounding 15.9 (1.9) 9.5 (0.9 ) 0.008
Heart rate, bpm
Before grounding 155 (3.7) 160 (3.1) 0.65
Grounding 154 (4.4) 158 (3.2) 0.82
After grounding 155 (4.3) 159 (2.8) 0.81
Values are expressed as mean (SE). Comparison of HRV pa-
rameters between 7 infants in open cribs compared with 13 infants
in closed incubators with heat on. Independent t tests were done
on the natural log-transformed data of all the parameters dis-
played. p < 0.05 is significant. LF, low-frequency; HF, high-fre-
quency; HRV, heart rate variability; SDNN, standard deviation of
beat-to-beat intervals between normal heart beats.
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Electrical Grounding Improves Vagal
Tone
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DOI: 10.1159/000475744
191
ter grounding. Interestingly, we found that the infants in
closed incubators had lower LF power and SDNN values
than the infants in open cribs before and after grounding.
During grounding there were no between-group differ-
ences in any of the HRV parameters ( Table4 ).
Discussion
This study showed that EG of preterm infants pro-
duced a significant increase in VT. VT reverted to the
pre-grounding level when EG was discontinued. The in-
crease in LF power may also reflect an increase in para-
sympathetic tone, as LF power combines sympathetic and
parasympathetic components. This study confirms an
earlier report which found that EG produces an increase
in VT in adults
[12] . This is the first time that EG has been
studied in the newborn.
Our study also confirmed a 60-Hz skin potential on
our preterm patients, as described by Applewhite
[10] .
This oscillating potential is induced by the ELF-EMF in
the electrical environment. We found that the infants’ VT
before being connected to ground was inversely propor-
tional to the skin potential. We also found that the skin
potential dropped immediately as the patients were con-
nected to ground. We found lower skin potentials in
those infants that were cared for in open cribs compared
to closed incubators; however, the study was not powered
to reveal any significance. There was a significantly lower
LF power and lower SDNN in the infants in closed incu-
bators compared to those in open cribs before and after
grounding. This effect was not seen with grounding, sug-
gesting that the between-group differences may have
been related to the influence of environmental electric
fields, which were higher in the closed incubators. We did
not test any infants that were in radiant warmers.
VT in preterm infants is a valuable marker of vulner-
ability to stress
[8] . Our own experience showed that the
risk of developing NEC increases by a factor of 10 for ev-
ery SD decrease in HF power
[9] . A causative link be-
tween low VT and NEC may be plausible, as VT has an
anti-inflammatory effect. Specifically, efferent vagal ac-
tivity on macrophages in the spleen and gastrointestinal
tract downregulates the production of inflammatory cy-
tokines in response to inflammation
[15] . Systemic in-
flammation is linked to neurodevelopmental delay in the
preterm infant
[16] ; therefore, strategies that dampen in-
flammation are clinically relevant.
The background MFD levels in the NICU were less
than 0.5 mG and were similar to general household levels.
The levels found in our incubators were lower than those
reported more than 10 years ago and may reflect an im-
proved engineering approach to incubator design
[3, 17] .
We confirmed that the MFD was very much dependent
on proximity to the power source. If we position infants
away from the power sources within incubators, we could
reduce their exposure to ELF-EMF 8-fold.
Epidemiological studies performed during pregnancy
showed increasing risks of asthma and obesity for the de-
veloping fetus when the expectant mother is exposed to a
daily MFD of 2 mG
[4, 5] , and the risk of developing
childhood leukemia doubles with postnatal exposure
above 4 mG
[18] . Accordingly, even though more than
2 mG (>0.2 μT) is associated with negative health conse-
quences on the growing fetus
[4–6] , values exceeding this
value are still commonly seen within our incubators and
also within 18 inches from equipment such as incubator
humidifier control panels.
An animal study showed that harmful effects of LF-
EMFs are mediated by oxidative injury to brain cells; an-
tioxidants can block these effects
[19] . EG makes an elec-
trical connection to the surface of the earth, which is
known to possess a supply of free, mobile electrons. These
electrons are continuously replenished by the global at-
mospheric electrical circuit, where the sources of elec-
trons are thunderstorms and lightning strikes
[20, 21] .
When the body is grounded, the body’s electric skin po-
tential becomes equalized with the earth’s electric poten-
tial through a transfer of electrons from the earth to the
body
[20] . This virtually eliminates the 60-Hz potential
on the surface of the body induced by the electrical envi-
ronment, and thus may prevent the fields from producing
electrical perturbations of molecules inside the body. Sec-
ondly, it is hypothesized that grounding provides access
to an abundant, immediate source of mobile electrons as
natural antioxidants
[22, 23] .
Disclosure Statement
K.K.D. and C.P. receive salary support for research by the Na-
tional Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK) of the National Institutes of Health under award No.
1R01DK099350 (K.K.D.). C.P. receives salary support from the
University City Science Center. None of the funding sources had
any role in the design of the study, in the analysis and interpreta-
tion of the data, in the decision to submit the manuscript, or in the
preparation, review, or approval of the manuscript.
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DOI: 10.1159/000475744
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... Earthing researchers from the Neonatal Intensive Care Unit (NICU) in the Penn State Children's Hospital in Hershey conducted Earthing therapy for preterm infants in NICU for two months. It resulted in a clinically stable infant and increased heart rate variability (HRV), indicating vagal nerve transmission (2). ...
... Direct contact with the earth allows the free transport of electrons from the earth's surface to spread to the body through the skin and provides an antioxidant effect. Electron transfer creates an antioxidant microenvironment in the inflamed area, slows or prevents reactive oxygen species (ROS) processes that occur due to oxidative bursts from causing "collateral damage" to healthy tissue, and prevents or reduces the formation of called "inflammatory barricades" (2). ...
... The vagal nerve extends from the brainstem to the abdomen. The primary nerve in the autonomic nervous system supplies and regulates vital organs, including the lungs, heart, and digestive system (2). The vagal nerve extends from the brainstem to the abdomen, which is the main nerve of the autonomic nervous system (2). ...
Article
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Preterm infants have compromised immune systems where the maturity of the organs and body system is not optimum. The compromised immune system makes premature infants susceptible to micro-bacterial infections. Acute respiratory infection is the most common infection among them. This study aimed to investigate the significant difference in the length of acute respiratory infection before and after Earthing therapy. This research is a quasi-experimental study. The location is Sukoharjo District, Indonesia, from March to August 2021. The population in this study is preterm infants whose data is obtained from monthly reports on Central Java Statistic Agency. The number of samples of preterm infants was 192 infants. The sample size was 20 infants. Earthing duration is 1 hour every day for 30 days. The statistical analysis results in a P-value of 0,000 and tcount 8.065>t table 2.093, indicating a significant difference in the length of Acute Respiratory Infections among preterm infants before and after Earthing therapy. It is recommended that mothers of preterm infants continue to utilize Earthing devices longer to increase the immune system and prevent acute respiratory infection. Furthermore, using Earthing therapy is beneficial for improving the general immune system in preventing or accelerating the healing process of microbial infection with Earthing devices or straight to the ground.
... Electromagnetic field coming from the incubator power influences the ANS as revealed by HRV analysis as LF/HF increases, whereas HF decreases (Bellieni et al., 2008). The farther away newborns stay from the incubator power, the less the ANS is affected (Bellieni et al., 2008;Passi et al., 2017). ...
Article
Full-text available
Il sistema nervoso autonomico (SNA) gioca un ruolo di rilievo nella regolazione della salute dell'organismo e dei suoi processi di adattamento agli stressor. Tuttavia, spesso viene data poca attenzione ai suoi legami con i sistemi immunitario ed endocrino. Ancor di più, poca attenzione viene data a come l'SNA si sviluppa durante la gestazione e a quali fattori possono interferire con la sua maturazione, nonostante oggi, tramite l'analisi della variabilità della frequenza cardiaca (HRV), è possibile monitorare lo sviluppo dell'SNA persino a livello fetale e prevenire complicazioni potenzialmente letali. Scopo di questo articolo è, pertanto, fornire un quadro della complessità dello sviluppo dell'SNA, con specifici accenni al nervo vago, con particolare attenzione ai fattori ambientali che possono interferire durante lo sviluppo fetale e neonatale, fornendo in conclusione rilevanti spunti per la pratica clinica.
... There were 11 different medication or medication groups, 9 different procedures, and 21 different maternal factors studied; a list of these 3 subgroups and their references is provided as table 6. There were 38 articles examining 17 other stimuli: respiratory support, 112 145-151 delivery mode, 20 69 77 121-123 137 phototherapy, 104 128 146 152 consoling devices, 32 34 59 153 154 electromagnetic field, 155 156 stress, 48 118 157 cocoon/swaddle, 64 158 transport, 129 hypoxic hypercapnia, 23 feeding protocol, 159 environmental tobacco smoke, 55 caregiving, 160 incubator temperature, 161 non-invasive electrical stimulation at acupuncture points, 162 CRIB versus incubator, 156 self-consoling behaviour 157 and family nurture intervention. 163 Outcome prediction N=30 articles examined HRV in relation to long-term outcomes at discharge and beyond. ...
Article
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Background Neonatal heart rate variability (HRV) is widely used as a research tool. However, HRV calculation methods are highly variable making it difficult for comparisons between studies. Objectives To describe the different types of investigations where neonatal HRV was used, study characteristics, and types of analyses performed. Eligibility criteria Human neonates ≤1 month of corrected age. Sources of evidence A protocol and search strategy of the literature was developed in collaboration with the McGill University Health Center’s librarians and articles were obtained from searches in the Biosis, Cochrane, Embase, Medline and Web of Science databases published between 1 January 2000 and 1 July 2020. Charting methods A single reviewer screened for eligibility and data were extracted from the included articles. Information collected included the study characteristics and population, type of HRV analysis used (time domain, frequency domain, non-linear, heart rate characteristics (HRC) parameters) and clinical applications (physiological and pathological conditions, responses to various stimuli and outcome prediction). Results Of the 286 articles included, 171 (60%) were small single centre studies (sample size <50) performed on term infants (n=136). There were 138 different types of investigations reported: physiological investigations (n=162), responses to various stimuli (n=136), pathological conditions (n=109) and outcome predictor (n=30). Frequency domain analyses were used in 210 articles (73%), followed by time domain (n=139), non-linear methods (n=74) or HRC analyses (n=25). Additionally, over 60 different measures of HRV were reported; in the frequency domain analyses alone there were 29 different ranges used for the low frequency band and 46 for the high frequency band. Conclusions Neonatal HRV has been used in diverse types of investigations with significant lack of consistency in analysis methods applied. Specific guidelines for HRV analyses in neonates are needed to allow for comparisons between studies.
... Electromagnetic field coming from the incubator power influences the ANS as revealed by HRV analysis as LF/HF increases, whereas HF decreases (Bellieni et al., 2008). The farther away newborns stay from the incubator power, the less the ANS is affected (Bellieni et al., 2008;Passi et al., 2017). ...
Article
Full-text available
The autonomic nervous system (ANS) is one of the main biological systems that regulates the body's physiology. Autonomic nervous system regulatory capacity begins before birth as the sympathetic and parasympathetic activity contributes significantly to the fetus' development. In particular, several studies have shown how vagus nerve is involved in many vital processes during fetal, perinatal, and postnatal life: from the regulation of inflammation through the anti-inflammatory cholinergic pathway, which may affect the functioning of each organ, to the production of hormones involved in bioenergetic metabolism. In addition, the vagus nerve has been recognized as the primary afferent pathway capable of transmitting information to the brain from every organ of the body. Therefore, this hypothesis paper aims to review the development of ANS during fetal and perinatal life, focusing particularly on the vagus nerve, to identify possible “critical windows” that could impact its maturation. These “critical windows” could help clinicians know when to monitor fetuses to effectively assess the developmental status of both ANS and specifically the vagus nerve. In addition, this paper will focus on which factors—i.e., fetal characteristics and behaviors, maternal lifestyle and pathologies, placental health and dysfunction, labor, incubator conditions, and drug exposure—may have an impact on the development of the vagus during the above-mentioned “critical window” and how. This analysis could help clinicians and stakeholders define precise guidelines for improving the management of fetuses and newborns, particularly to reduce the potential adverse environmental impacts on ANS development that may lead to persistent long-term consequences. Since the development of ANS and the vagus influence have been shown to be reflected in cardiac variability, this paper will rely in particular on studies using fetal heart rate variability (fHRV) to monitor the continued growth and health of both animal and human fetuses. In fact, fHRV is a non-invasive marker whose changes have been associated with ANS development, vagal modulation, systemic and neurological inflammatory reactions, and even fetal distress during labor.
... EMF coming from the incubator power influences the ANS as revealed by HRV analysis as LF/HF increases, whereas HF decreases (Bellieni et al., 2008). The farther away newborns stay from the incubator power, the less the ANS is affected (Bellieni et al., 2008;Passi et al., 2017). ...
Preprint
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The autonomic nervous system (ANS) regulatory capacity begins before birth as the sympathetic and parasympathetic activity contributes significantly to the fetus' development. Several studies have shown how vagus nerve is involved in many vital processes during fetal, perinatal and postnatal life: from the regulation of inflammation through the anti-inflammatory cholinergic pathway, which may affect the functioning of each organ, to the production of hormones involved in bioenergetic metabolism. In addition, the vagus nerve has been recognized as the primary afferent pathway capable of transmitting information to the brain from every organ of the body. Therefore, this hypothesis paper aims to review the development of ANS during fetal and perinatal life, focusing particularly on the vagus nerve, to identify possible "critical windows" that could impact its maturation. These "critical windows" could help clinicians know when to monitor fetuses to effectively assess the developmental status of both ANS and specifically the vagus nerve. In addition, this paper will focus on which factors (i.e. fetal characteristics and behaviors, maternal lifestyle and pathologies, placental health and dysfunction, labor, incubator conditions, and drug exposure) may have an impact on the development of the vagus during the above-mentioned "critical window" and how. This analysis could help clinicians and stakeholders define precise guidelines for improving the management of fetuses and newborns, particularly to reduce the potential adverse environmental impacts on ANS development that may lead to persistent long-term consequences. Since the development of ANS and the vagus influence have been shown to be reflected in cardiac variability, this paper will rely in particular on studies using fetal heart rate variability (fHRV) to monitor the continued growth and health of both animal and human fetuses.
... This technique has a significant impact on the autonomic nervous system (ANS). A study of premature infants has shown that grounding has resulted in immediate and substantial improvement in ANS measurements, which are important in controlling inflammatory responses and stress responses in those babies [32]. It may be because of the rapid transit movement of the electron that triggers the nerve vagus. ...
Article
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Acupressure in Oriental medicine is used as a core therapeutic method due to its therapeutic efficacy and minimal side-effects. However, microcurrent stimulation, combined with acupressure and grounding, has not been studied under acupressure conditions in terms of how this combination might affect acupressure therapy's effectiveness. This paper clarifies the new concept of acupressure stimulation combined with a microcurrent that generates electron flow during earthing. In grounding the body, there is free electron movement from and to the body that creates microcurrent. Acupressure uses these currents to activate specific acupoints for therapeutic purposes and activating these acupoints adjust the imbalance between Qi across channels (meridians) and ultimately treat diseases. It is time for proper research and implementation of this technique to increase acupressure efficacy and reduce society's cost.
... In addition, the portable device can easily be converted to a wearable device for future application because of its small size of 10 × 6 × 3 cm. Compared with the expensive and complicated bio-amplifiers on the market [30], our device focuses on the acquisition of SP signals. Therefore, our device is cheaper and more convenient to use. ...
Article
Full-text available
Emotion recognition is of great importance for artificial intelligence, robots, and medicine etc. Although many techniques have been developed for emotion recognition, with certain successes, they rely heavily on complicated and expensive equipment. Skin potential (SP) has been recognized to be correlated with human emotions for a long time, but has been largely ignored due to the lack of systematic research. In this paper, we propose a single SP-signal-based method for emotion recognition. Firstly, we developed a portable wireless device to measure the SP signal between the middle finger and left wrist. Then, a video induction experiment was designed to stimulate four kinds of typical emotion (happiness, sadness, anger, fear) in 26 subjects. Based on the device and video induction, we obtained a dataset consisting of 397 emotion samples. We extracted 29 features from each of the emotion samples and used eight well-established algorithms to classify the four emotions based on these features. Experimental results show that the gradient-boosting decision tree (GBDT), logistic regression (LR) and random forest (RF) algorithms achieved the highest accuracy of 75%. The obtained accuracy is similar to, or even better than, that of other methods using multiple physiological signals. Our research demonstrates the feasibility of the SP signal’s integration into existing physiological signals for emotion recognition.
... Electromagnetic field coming from the incubator power influences the ANS as revealed by HRV analysis as LF/HF increases, whereas HF decreases (Bellieni et al., 2008). The farther away newborns stay from the incubator power, the less the ANS is affected (Bellieni et al., 2008;Passi et al., 2017). ...
Article
Full-text available
Le cure di routine nelle terapie intensive neonatali (TIN) si basano soprattuttosu procedure manuali. Negli ultimi anni, diversi studi hanno mostrato come il tocco influenzi lo sviluppo dei bambini, soprattutto se pretermine, ma mancano studi sulla palpazione come strumento di valutazione clinica. Pertanto, gli autori propongono il modello Neonatal Assessment Manual scorE (NAME), una procedura di valutazione basata sul tocco che potrebbe aiutare l'equipe delle TIN. Il NAME mira a valutare come il corpo del bambino si adatta a pressioni manuali gentili. Stimolando meccanorecettori a bassa soglia, queste pressioni possono indurre una complessa risposta neurologica che può alterare l'emodinamica e il ritmo respiratorio del bambino, così come il suo volume corporeo. L'operatore può avvertire questi cambiamenti tramite la percezione aptica e ottenere informazioni riguardanti lo sviluppo e le condizioni cliniche del bambino, in quanto la risposta corporea dipende da essi. Se futuri studi dovessero confermarne la validità e l'affidabilità nella pratica clinica, il NAME potrebbe diventare parte delle cure di routine neonatali.
... When the incubator power is turned on, LF/HF increases, whereas HF decreases (Bellieni et al., 2008). Positioning the newborn as far away as possible from the incubator power can limit and reverse these effects (Bellieni et al., 2008;Passi et al., 2017). ...
Article
Full-text available
Neonatal intensive care units (NICUs) greatly expand the use of technology. There is a need to accurately diagnose discomfort, pain, and complications, such as sepsis, mainly before they occur. While specific treatments are possible, they are often time-consuming, invasive, or painful, with detrimental effects for the development of the infant. In the last 40 years, heart rate variability (HRV) has emerged as a non-invasive measurement to monitor newborns and infants, but it still is underused. Hence, the present paper aims to review the utility of HRV in neonatology and the instruments available to assess it, showing how HRV could be an innovative tool in the years to come. When continuously monitored, HRV could help assess the baby’s overall wellbeing and neurological development to detect stress-/pain-related behaviors or pathological conditions, such as respiratory distress syndrome and hyperbilirubinemia, to address when to perform procedures to reduce the baby’s stress/pain and interventions, such as therapeutic hypothermia, and to avoid severe complications, such as sepsis and necrotizing enterocolitis, thus reducing mortality. Based on literature and previous experiences, the first step to efficiently introduce HRV in the NICUs could consist in a monitoring system that uses photoplethysmography, which is low-cost and non-invasive, and displays one or a few metrics with good clinical utility. However, to fully harness HRV clinical potential and to greatly improve neonatal care, the monitoring systems will have to rely on modern bioinformatics (machine learning and artificial intelligence algorithms), which could easily integrate infant’s HRV metrics, vital signs, and especially past history, thus elaborating models capable to efficiently monitor and predict the infant’s clinical conditions. For this reason, hospitals and institutions will have to establish tight collaborations between the obstetric, neonatal, and pediatric departments: this way, healthcare would truly improve in every stage of the perinatal period (from conception to the first years of life), since information about patients’ health would flow freely among different professionals, and high-quality research could be performed integrating the data recorded in those departments.
... They found that Earthing premature infants produced immediate and significant improvements in measurements of autonomic nervous system (ANS) functioning critically important in the regulation of inflammatory and stress responses. 19 Earthing the babies significantly increased heart rate variability (HRV) indicative of improved vagal tone. HRV refers to beat-to-beat alterations in heart rate, and is influenced by the sympathetic and parasympathetic branches of the ANS. ...
Article
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Earthing (also known as grounding) refers to the discovery that bodily contact with the Earth's natural electric charge stabilizes the physiology at the deepest levels, reduces inflammation, pain, and stress, improves blood flow, energy, and sleep, and generates greater well-being. Such effects are profound, systemic, and foundational, and often develop rapidly. Earthing is as simple as routinely walking barefoot outdoors and/or using inexpensive grounding systems indoors while sleeping or sitting, practices that restore a lost and needed electric connection with the Earth. Some 20 studies to date have reported intriguing evidence of wide and significant physiological improvements when the body is grounded vs. non-grounded. The research, along with numerous anecdotal reports, demonstrates that Earthing clearly deserves inclusion in the clinical practice of preventive, alternative, and lifestyle medicine and has great potential to render these approaches more effective.
Article
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Multi-disciplinary research has revealed that electrically conductive contact of the human body with the surface of the Earth (grounding or earthing) produces intriguing effects on physiology and health. Such effects relate to inflammation, immune responses, wound healing, and prevention and treatment of chronic inflammatory and autoimmune diseases. The purpose of this report is two-fold: to 1) inform researchers about what appears to be a new perspective to the study of inflammation, and 2) alert researchers that the length of time and degree (resistance to ground) of grounding of experimental animals is an important but usually overlooked factor that can influence outcomes of studies of inflammation, wound healing, and tumorigenesis. Specifically, grounding an organism produces measurable differences in the concentrations of white blood cells, cytokines, and other molecules involved in the inflammatory response. We present several hypotheses to explain observed effects, based on current research results and our understanding of the electronic aspects of cell and tissue physiology, cell biology, biophysics, and biochemistry. An experimental injury to muscles, known as delayed onset muscle soreness, has been used to monitor the immune response under grounded versus ungrounded conditions. Grounding reduces pain and alters the numbers of circulating neutrophils and lymphocytes, and also affects various circulating chemical factors related to inflammation.
Article
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Preterm birth and infectious diseases are the most common causes of neonatal and early childhood deaths worldwide. The rates of preterm birth have increased over recent decades and account for 11% of all births worldwide. Preterm infants are at significant risk of severe infection in early life and throughout childhood. Bacteraemia, inflammation, or both during the neonatal period in preterm infants is associated with adverse outcomes, including death, chronic lung disease, and neurodevelopmental impairment. Recent studies suggest that bacteraemia could trigger cerebral injury even without penetration of viable bacteria into the CNS. Here we review available evidence that supports the concept of a strong association between bacteraemia, inflammation, and cerebral injury in preterm infants, with an emphasis on the underlying biological mechanisms, clinical correlates, and translational opportunities.
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Background Necrotizing enterocolitis (NEC) is an acute neonatal inflammatory disease which may lead to intestinal necrosis, multisystem failure, and death. Currently, NEC is diagnosed by a combination of laboratory and radiographic tests conducted a posteriori i.e., when NEC is already clinically significant. Given the acute onset and rapid progression of NEC, a non-invasive biomarker that allows early detection of patients at risk is required as a matter of urgency. We evaluated whether the high frequency (HF) component of heart rate variability (HRV), a measure of vagal efferent tonic cholinergic activity may be used as a predictive biomarker for NEC-risk before the onset of clinical disease.Methods In this prospective study, stable preterm (gestational age 28–35 weeks) infants had HRV power spectra analyzed from surface electrocardiogram waveforms taken at rest on day 5–8 of life. We used regression modeling to determine the utility of HF-HRV in predicting NEC.Key ResultsHF-HRV power was 21.5 ± 2.7 and 3.9 ± 0.81 ms2 in infants that remained healthy and those that later developed stage 2+ NEC, respectively (p < 0.001). Nine of 70 enrolled infants developed NEC. The ROC discriminated a HF-HRV value of 4.68 ms2 predictive for developing NEC with a sensitivity and specificity of 89% and 87%, and positive and negative predictive value of 50% and 98%, respectively. With predictive regression modeling, the risk (odds ratio) of developing NEC was 10 per every one SD decrease in HF-HRV.Conclusions & InferencesOur preliminary data indicate that HF-HRV may serve as a potential, non-invasive predictive biomarker of NEC-risk in NICU infants.
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We conducted a prospective study to examine whether in-utero exposure to magnetic fields (MFs) increases the risk of childhood obesity. Participating women carried a meter measuring MF levels during pregnancy and 733 of their children were followed up to 13 years to collect clinically recorded information on growth patterns with 33 weight measurements per child on average. Prenatal exposure to high MF level was associated with increased risk of being obese in offspring than those with lower MF level (odds ratio = 1.69, 95% confidence interval: 1.01-2.84). The association demonstrated a dose-response relationship and was stronger (more than 2.3 fold increased risk) among children who were followed up to the end of the study. The association existed only for persistent obesity, but not for transitory (unlikely) obesity. Maternal exposure to high MF during pregnancy may be a new and previously unknown factor contributing to the world-wide epidemic of childhood obesity/overweight.
Article
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Environmental medicine generally addresses environmental factors with a negative impact on human health. However, emerging scientific research has revealed a surprisingly positive and overlooked environmental factor on health: direct physical contact with the vast supply of electrons on the surface of the Earth. Modern lifestyle separates humans from such contact. The research suggests that this disconnect may be a major contributor to physiological dysfunction and unwellness. Reconnection with the Earth's electrons has been found to promote intriguing physiological changes and subjective reports of well-being. Earthing (or grounding) refers to the discovery of benefits-including better sleep and reduced pain-from walking barefoot outside or sitting, working, or sleeping indoors connected to conductive systems that transfer the Earth's electrons from the ground into the body. This paper reviews the earthing research and the potential of earthing as a simple and easily accessed global modality of significant clinical importance.
Article
Ultralow frequency pulsations of electric field in the surface atmospheric layer were investigated under fair weather conditions. A new method of structural-temporal analysis has been applied to the study of spatiotemporal structures of the electric field described previously by [Anisimov et al., 1994]. The method is based on exploration of the structural function by averaging the remote sensing data over respective temporal spans. This analysis allows quantitative estimations of spatial scales L ≃ 500 - 103 m and temporal scales not less than τ = 10 min for the structural elements of the planetary boundary layer electricity; we call these recently examined elements "aeroelectric structures" (AES). Quasiperiodic sequences and high-amplitude solitary AES have been recognized. Three-dimensional structural-temporal patterns are presented which directly characterize the level of electric energy perturbations connected with AES formation during night-day evolution. A model of AES formation has been developed, taking into account the occurence of convective cells with respective turbulent air and space charge density distributions that are transferred by the wind over the ground and cause the electric field fluctuations at the points of observation. Therefore formation of such submesoscale structures can be explained by the redistribution of space charge within the surface layer, with the structures of the smallest scales coupled to the turbulent mixing of the ions and aerosols. In addition to the advection and turbulent mixing of space charge, we also consider the cooperative electroaerodynamic effects which might occur in a system of bipolar ion and aerosol particles under the influence of a terrestrial electric field. We have proposed an advanced model treating the AES formation as the result of instability arising in such a system, taking into account the dependence of the effective ion-aerosol attachment coefficient on the external electric field strength.
Article
Effects of light and electromagnetic fields (EMFs) on pineal function could have implications for long-term risk of breast cancer, reproductive irregularities, or depression. Health-care workers in a neonatal intensive care unit (NICU) were interviewed to determine the tasks, work locations, and practices in their work environment as well as the care provided to the infants. After an initial visit, methods for measuring illuminance, luminance, and broadband resultant magnetic fields throughout the NICU were developed. Measurements were made of one nursery during a daytime (1:00 p.m.) and a night-time (12:30 a.m.) visit. Measurements relevant to both nurses and premature infants in the NICU were made. Some measurements could not be completed so as not to interfere with nurses' duties in the NICU. Illuminances measured during the daytime and nighttime averaged 184 and 34 lux (lx), respectively, much lower than those reported in other studies of illuminance in NICUs, with a maximum illuminance of 747 lx. Peak levels may be consistent with those thought to suppress melatonin. There was a high degree of variability in EMF levels, which exceeded 1,000 mG close to certain hospital equipment but averaged 1-2 mG at the nurses' workstation. Fields within incubators exceeded 10 mG.