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Published on: February 14, 2021
Gestational age at birth affects maturation of baroreflex control
Karinna L Fyfe1, Stephanie R Yiallourou1, Flora Y Wong2
1The Ritchie Centre, Monash Institute of Medical Research and Prince Henry's Institute and Monash University, Melbourne, Victoria, Australia; The Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
Insights
Prone sleeping may impair blood pressure control in very preterm infants. Their baroreflex sensitivity (BRS) matures slower, potentially increasing cardiovascular risks later in life.
Area of Science:
- Neonatal physiology
- Cardiovascular regulation
- Sleep studies
Background:
- Prone sleeping is a major risk factor for sudden infant death syndrome (SIDS).
- Cardiovascular control mechanisms mature throughout infancy, particularly in preterm infants.
- Baroreflex sensitivity (BRS) is a key indicator of autonomic cardiovascular regulation.
Purpose of the Study:
- To investigate the impact of prone sleeping position on blood pressure (BP) control in preterm infants.
- To assess the maturation of BRS in very preterm, preterm, and term infants across different postterm ages.
Main Methods:
- Daytime polysomnography was conducted on 52 infants (21 very preterm, 14 preterm, 17 term) at 2-4 weeks, 2-3 months, and 5-6 months postterm.
- Blood pressure (BP) was measured using a Finometer cuff on the wrist in both supine and prone positions.
- Baroreflex sensitivity (BRS) was calculated using cross-spectral analysis of spontaneous BP fluctuations.
Main Results:
- Very preterm infants exhibited lower BRS in the prone position during active sleep at 2-4 weeks postterm (P < .05).
- The maturation of BRS was significantly delayed in very preterm infants compared to preterm and term infants.
- These findings suggest altered autonomic cardiovascular regulation in very preterm infants.
Conclusions:
- Maturation of BRS is altered in very preterm infants after term-equivalent age.
- Reduced BRS may impair the ability of very preterm infants to respond to cardiovascular stress.
- This impaired response could predispose very preterm infants to future cardiovascular disease.
Objectives:
To assess the effect of prone sleeping, the major risk factor for sudden infant death syndrome, in the control of blood pressure (BP) in preterm infants born across a range of gestational ages.
Study Design:
Daytime polysomnography was performed at 2-4 weeks, 2-3 months, and 5-6 months postterm age. The participants were 21 very preterm (mean gestation 29.4 ± 0.3 weeks), 14 preterm (mean gestation 33.1 ± 0.3 weeks), and 17 term (mean gestation 40.1 ± 0.3 weeks). BP was measured via a Finometer cuff (Finapres Medical Systems, Amsterdam, The Netherlands) placed around the wrist. Data were recorded both supine and prone. Baroreflex sensitivity (BRS) was calculated via cross-spectral analysis of spontaneous fluctuations in BP.
Results:
BRS was lower in the prone position in very preterm infants at 2-4 weeks in active sleep (P < .05). Maturation of BRS was delayed in very preterm compared with both preterm and term infants.
Conclusions:
Maturation of BRS after term-equivalent age is altered in very preterm infants. Reduced BRS may result in an impaired ability of very preterm infants to respond to cardiovascular stress during infancy and may predispose them to cardiovascular disease later in life.
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