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Developmental changes in infant heart rate responses to head-up tilting
Michael M Myers1, Esperanza Gomez-Gribben, Kiersten S Smith
1Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, USA. mmm3@columbia.edu
Insights
Newborn infants show significant heart rate changes when tilted, but this response diminishes by 2-4 months of age. This study investigated rapid tilting to understand these developmental changes in cardiac autonomic regulation.
Area of Science:
- Physiology
- Neonatal Development
- Autonomic Nervous System Function
Background:
- Newborn infants exhibit robust heart rate responses to head-up and head-down tilting.
- Previous research indicated a loss of significant heart rate increase to slow head-up tilting by 2-4 months of age.
Purpose of the Study:
- To determine if 2-4-month-old infants demonstrate significant heart rate increases during rapid head-up tilting.
- To investigate developmental changes in cardiac autonomic responses to hypotensive challenges.
Main Methods:
- Fifty-four infants were assessed at newborn and 2-4 month stages.
- Heart rate was measured during 30-degree head-up tilting at slow (30s) and rapid (5s) speeds.
Main Results:
- Newborns showed significant heart rate increases with both slow and rapid tilting.
- Infants at 2-4 months of age did not exhibit significant heart rate changes regardless of tilt speed.
Conclusions:
- Significant developmental changes occur in infant cardiac responses to hypotensive challenges.
- Newborns' sustained heart rate responses to head-up tilting resemble adults, but this diminishes by 2-4 months.
- Tilt testing may offer a standardized method for assessing autonomic competence in infants, particularly during the vulnerable period for sudden infant death syndrome.
Aim:
Newborn infants produce significant heart rate responses to both head-up and head-down tilting: heart rate increases with head-up tilting and decreases with head-down tilting. However, previously we found that, at 2-4 mo of age, heart rate increases were no longer significant following slow head-up tilting. This study was designed to determine if 2-4-mo-old infants have significant increases in heart rate when tilted rapidly.
Methods:
Fifty-four infants were tested as newborns or at 2-4 mo of age. Heart rate was measured while infants were tilted to a 30 degrees head-up angle either slowly over a period of 30 s or rapidly in 5 s.
Results:
Newborns exhibited increases in heart rate using both tilt speeds; however, at 2-4 mo of age, heart rate did not change significantly using either speed of tilting.
Conclusion:
There are significant early developmental changes in cardiac responses to hypotensive challenge. Newborns react like adults, mounting sustained increases in heart rate in response to head-up tilting, but at 2-4 mo of age sustained heart rate responses are no longer significant. Tilt tests may provide a standardized method for assessing autonomic competence during the period of maximum vulnerability to sudden infant death syndrome.
