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Heart rate variability in preterm brain-injured and very-low-birth-weight infants
B D Hanna1, M N Nelson, R C White-Traut
1University of Illinois at Chicago, College of Nursing and Rush Children's Hospital at Rush-Presbyterian-St. Luke's Medical Center, The Rush Children's Heart Center,60612, USA.
Insights
Heart rate variability (HRV) patterns in newborns with brain injury predict neurodevelopmental outcomes. HRV analysis can help assess injury severity and forecast long-term results in at-risk infants.
Area of Science:
- Neonatal neurology
- Cardiovascular physiology
- Developmental pediatrics
Background:
- Heart rate variability (HRV) reflects autonomic nervous system control of the heart.
- HRV changes predictably with fetal and newborn development.
- Altered HRV patterns are linked to clinical outcomes in various conditions.
Purpose of the Study:
- To characterize maturational HRV patterns in at-risk newborns with brain injury.
- To correlate HRV with hospital stay, cerebral palsy diagnosis, and 1-year neurodevelopmental scores.
Main Methods:
- Longitudinal HRV analysis (time domain indices) from 32 to 37 weeks corrected gestational age.
- Study included 19 very low birth weight preterm infants with varying degrees of brain injury (PVL, IVH).
- Neurologic injury assessed by ultrasound; neurodevelopment tracked to 1 year corrected age.
Main Results:
- Perinatal brain injury type strongly correlated with specific HRV patterns (adjusted r² 0.63–0.99).
- Brain injury type was highly correlated with neurodevelopmental outcomes (p < 0.0000).
- HRV correlated with hospital stay and 1-year neurodevelopmental function.
Conclusions:
- The type of perinatal brain injury dictates HRV patterns in at-risk newborns.
- HRV is a significant predictor of neurodevelopmental outcomes and hospital stay.
- HRV analysis offers valuable insights into the impact of brain injury on infant development.
Abstract:
Heart rate variability (HRV) reflects the complex interplay of the sympathetic and parasympathetic innervation of the heart. Developmental maturation of the fetus and newborn results in predictable alterations in the neural cardiac control of heart rate. Furthermore, patterns of HRV are closely correlated to clinical outcome in several pathologic situations. The first aim of this study was to characterize the maturational patterns of HRV in a group of developmentally at-risk newborns (those with severe hemorrhagic or ischemic brain injury and extremely immature, low-birth-weight infants). Secondly, we sought to determine whether a correlation exists between HRV and length of hospital stay, diagnosis of cerebral palsy, and neurodevelopmental test scores at 1-year corrected age. Time domain indices of HRV were computed longitudinally from 32 to 37 weeks of corrected gestational age in 19 very low birth weight, preterm infants. Among the 19 infants studied, 7 infants had no evidence of brain injury, 7 infants had periventricular leukomalacia (PVL), 3 infants had grade III/IV intraventricular hemorrhage (IVH), and 2 infants had both IVH and PVL. Neurologic injuries were documented using ultrasound and neurodevelopmental progress was followed through 1 year of corrected gestational age. A multivariate repeated measures analysis was performed to determine the relationship between the type of perinatal brain injury and neurodevelopmental status at 1 year of corrected gestational age. The type of perinatal brain injury was highly correlated to specific patterns of HRV with multivariate regression models producing adjusted r(2) values ranging from 0.63 to 0.99. The type of perinatal brain injury was highly correlated to the developmental outcome measures (p < 0.0000) with PVL patients having the lowest neurodevelopmental scores, IVH patients having the highest scores, and noninjured infants having midrange, grossly normal values. Using ANOVA, HRV was correlated to outcome, but individual comparisons revealed statistical significance only for the noninjured group (p < 0.04). However, multivariate models, which characterized outcome within each brain injury group, were highly significant (adjusted r (2) ranged from 0.23 to 0.89). In summary, the type of perinatal brain injury determined the pattern of HRV and HRV was highly correlated to length of hospital stay and neurodevelopmental function assessed at 1 year of corrected gestational age.