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The Impact of Surgical Patent Ductus Arteriosus Closure on Autonomic Function in Premature Infants
Nickie N Andescavage1,2, Marina Metzler3, Vedavalli Govindan3
1Division of Neonatology, Children's National Health System, Washington, District of Columbia.
Insights
Patent ductus arteriosus (PDA) is common in premature infants. Surgical closure of PDA did not alter heart rate variability (HRV) metrics in preterm infants, though autonomic function improves with advancing gestational age.
Area of Science:
- Neonatal physiology
- Autonomic nervous system function
- Cardiovascular research
Background:
- Patent ductus arteriosus (PDA) is a frequent complication in premature infants, associated with adverse outcomes.
- Surgical PDA ligation poses a significant risk for neurodevelopmental injury in these vulnerable infants.
- Autonomic dysfunction is a known concern in premature infants diagnosed with PDA.
Purpose of the Study:
- To investigate autonomic nervous system function in preterm infants with PDA.
- To analyze advanced heart rate variability (HRV) metrics before and after surgical PDA closure.
- To assess the impact of surgical intervention on autonomic regulation.
Main Methods:
- Prospective, observational study design.
- Inclusion of 27 infants born before 28 weeks' gestation.
- Continuous ECG monitoring for 6 hours pre- and post-surgery.
- Detrended fluctuation analysis of HRV to determine RMS and alpha components.
Main Results:
- Gestational age positively correlated with RMSL, RMSS, and αS, and negatively with αL.
- No significant differences in HRV parameters (RMSs, RMSL, αS, αL) were observed before and after surgical PDA closure.
- A statistically significant decrease in median heart rate was noted post-surgery (p < 0.01).
Conclusions:
- Increasing gestational age is strongly linked to enhanced HRV in preterm infants.
- Surgical ligation of PDA does not appear to impact HRV in the postoperative period.
- Autonomic nervous system function, as measured by HRV, remains stable post-surgical intervention for PDA.
Abstract:
Background Patent ductus arteriosus (PDA) is a common complication of prematurity and a risk factor for poor outcome. Infants undergoing surgical PDA ligation are at highest risk for neurodevelopmental injury. Autonomic dysfunction has been described in premature infants with PDA. Aim To interrogate the autonomic nervous system by analysis of advanced heart rate variability (HRV) metrics before and after surgical closure of the PDA. Study Design Prospective, observational study. Subjects Twenty-seven infants born before 28 weeks' gestation were included in this study. Methods Continuous electrocardiogram data were sampled at a rate of 125 Hz for a total of 6 hours before and 6 hours after 30 hours of surgical closure. HRV was determined by detrended fluctuation analysis to calculate the short and long root mean square (RMSL and RMSS) and α components at two time scales (long and short). Results Gestational age (GA) was positively associated with RMSL, RMSS, and αS and was negatively associated with αL. There was no difference between RMSs, RMSL, αS, or αL before and after surgery; however, median heart rate was lower after surgery (p < 0.01). Conclusion Advancing GA is highly associated with increasing HRV; however, surgical ligation does not affect HRV in the postoperative period.
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