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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Autonomic alterations in cocaine-exposed neonates following orthostatic stress
Vijay John1, Hongying Dai, Ajay Talati
1Joint Biomedical Engineering Program, University of Tennessee, Memphis, TN 38163, USA.
Insights
Prenatal cocaine exposure (PCE) in neonates alters cardiovascular responses to stress. PCE infants show delayed heart rate and heart rate variability reactions to orthostatic challenges, indicating potential long-term effects on autonomic system development.
Area of Science:
- Neonatal physiology
- Cardiovascular research
- Developmental toxicology
Background:
- Prenatal cocaine exposure (PCE) is a significant concern impacting fetal development.
- Neonatal cardiovascular regulation is crucial for adaptation after birth.
- Orthostatic stress challenges the autonomic nervous system's ability to maintain homeostasis.
Purpose of the Study:
- To investigate the effects of prenatal cocaine exposure (PCE) on heart rate (HR) and heart rate variability (HRV) in neonates under orthostatic stress.
- To compare cardiovascular responses to orthostatic challenges between PCE-exposed and control neonates.
- To elucidate the impact of PCE on the development of sympathetic and parasympathetic nervous system function.
Main Methods:
- Recruitment of near- and full-term neonates exposed (n=21) and unexposed (n=23) to PCE within 120 hours of birth.
- Electrocardiogram (ECG) recordings during quiet sleep, supine, and inclined positions to assess orthostatic stress.
- Analysis of heart rate and heart rate variability using linear mixed models, wavelet, and power spectrum analyses.
Main Results:
- Prenatal cocaine exposure (PCE) neonates exhibited tachycardia both before and after tilting, with a significant interaction between PCE and orthostatic stress (p=0.049).
- PCE infants displayed a delayed and prolonged cardiovascular reaction to orthostatic stress compared to controls.
- Heart rate variability (SDDRR) analysis revealed a pronounced interaction (p=0.049), with PCE infants showing a gradual, non-dissipating increase in response to stress.
Conclusions:
- Prenatal cocaine exposure (PCE) significantly alters neonatal cardiovascular function and autonomic responses to orthostatic stress.
- The findings suggest that PCE may lead to altered development of sympathetic and parasympathetic systems, impacting cardiovascular regulation.
- These alterations in cardiovascular function and autonomic response highlight potential long-term health implications for infants exposed to cocaine prenatally.
Abstract:
We investigated the effects of prenatal cocaine exposure (PCE) on heart rate (HR) and heart rate variability (HRV) in the presence of orthostatic stress among near- and full-term neonates. PCE infants (n = 21) and controls (n = 23) were enrolled within 120 h of birth. ECG was recorded for an hour during quiet sleep, 30 min in supine position and then 30 min in an inclined position. Linear mixed models were used to analyze HR and HRV in the time domain and wavelet and power spectrum analyses in the frequency domain. PCE infants had tachycardia both before (p = 0.091) and after tilting (p = 0.015), but with a clear interaction between PCE and orthostatic stress (p = 0.049). Compared with controls, PCE infants had a delayed and prolonged reaction to orthostatic stress. There was also a pronounced interaction with regard to log-transformed SDDRR, a measure of HRV (p = 0.049). Controls experienced an instantaneous increase in log (SDDRR) followed by a prompt return to normal levels, while PCE infants had a gradual increase that did not dissipate quickly. Frequency-domain analyses also distinguished between the cocaine-exposed infants and the controls. Results suggest that the effects of PCE on the development of sympathetic and parasympathetic systems could lead to altered cardiovascular function.
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