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Autonomic reflexes in preterm infants.

H Lagercrantz1, D Edwards, D Henderson-Smart

  • 1Department of Paediatrics, Karolinska Hospital, Stockholm, Sweden.

Acta Paediatrica Scandinavica
|August 1, 1990
PubMed
Summary
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Autonomic nervous system reflexes were tested in preterm infants. Abnormal reflexes were linked to apnea, bradycardia, and increased sympathetic activity, suggesting potential diagnostic markers.

Area of Science:

  • Neonatal Physiology
  • Autonomic Nervous System Function

Background:

  • Autonomic nervous system (ANS) reflexes are crucial for maintaining homeostasis.
  • Standardized ANS reflex testing is common in adults but less established in preterm infants.
  • Preterm infants may exhibit altered ANS function, particularly those with apnea and bradycardia or prenatal exposure to sympathicolytic drugs.

Purpose of the Study:

  • To adapt and validate autonomic nervous reflex tests for preterm infants.
  • To investigate differences in ANS function between preterm infants with and without recurrent apnea and bradycardia.
  • To assess ANS responses in infants exposed to sympathicolytic drugs prenatally.

Main Methods:

  • Peripheral vascular resistance was measured during head-up tilting to assess sympathetic activity.

Related Experiment Videos

  • Parasympathetic activity was evaluated by measuring heart rate changes during cold face tests and laryngeal stimulation.
  • Heart rate variability following a sudden acoustic stimulus was analyzed for sympathetic and vagal responses.
  • An autonomic nervous reflex score was computed based on these measurements.

    • Main Results:

    • Peripheral vascular resistance was generally low in preterm infants, decreasing further around two months postnatally.
    • Head-up tilting did not alter heart rate or mean blood pressure but increased peripheral resistance.
    • Cold face and laryngeal stimulation elicited significant heart rate decreases (20.0% and 23.7%, respectively).
    • Sudden noise typically induced a biphasic heart rate response.
    • A negative reflex score (parasympathetic dominance) was observed in infants with apnea and bradycardia.
    • A positive reflex score (sympathetic dominance) was found in infants with signs of increased sympathetic activity.

    Conclusions:

    • Autonomic nervous reflex testing can be adapted for preterm infants.
    • Infants with recurrent apnea and bradycardia show parasympathetic nervous system alterations.
    • Preterm infants with clinical signs of increased sympathetic activity exhibit distinct ANS responses.
    • These reflex tests may serve as valuable tools for assessing autonomic function in preterm neonates.