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Fetal-growth-restricted preterm infants display compromised autonomic cardiovascular control on the first postnatal
Emily Cohen1, Flora Y Wong1, Euan M Wallace2
1The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics Monash University, Melbourne, Victoria, Australia.
Insights
Preterm infants with fetal growth restriction (FGR) show reduced heart rate variability (HRV) at birth, indicating potential circulatory issues. However, these autonomic differences in FGR infants appear to resolve by 6 months post-term.
Area of Science:
- Neonatal Physiology
- Cardiovascular Autonomic Control
- Fetal Growth Restriction Research
Background:
- Fetal growth restriction (FGR) is linked to higher perinatal mortality and long-term health problems.
- FGR may affect the development of autonomic control of heart rate and blood pressure.
- Understanding these impacts is crucial for improving outcomes in FGR infants.
Purpose of the Study:
- To investigate the impact of FGR on autonomic cardiovascular control in preterm infants.
- To compare heart rate variability (HRV) and baroreflex sensitivity between FGR and appropriate for gestational age (AGA) infants.
- To assess changes in autonomic control from birth to 6 months post-term.
Main Methods:
- Studied preterm FGR infants, preterm AGA infants, and term AGA infants.
- Measured heart rate variability (HRV) and baroreflex sensitivity using spectral and transfer-function analyses.
- Infants were assessed on postnatal day 1 and at 1 and 6 months post-term.
Main Results:
- Preterm FGR neonates had higher heart rates and reduced HRV compared to preterm AGA controls on day 1.
- No significant differences in HRV or baroreflex sensitivity were observed at 1 or 6 months post-term.
- These findings suggest transient autonomic dysfunction in early infancy for FGR infants.
Conclusions:
- Preterm FGR neonates exhibit compromised HRV shortly after birth, indicating potential circulatory instability.
- This early compromise may increase risks for systemic/cerebral hypoperfusion and neurodevelopmental issues.
- Autonomic cardiovascular control maturation appears preserved by 6 months post-term, suggesting recovery.
Abstract:
BackgroundFetal growth restriction (FGR) is associated with increased perinatal mortality and long-term cardiovascular and neurodevelopmental sequelae. We hypothesized that FGR impacts on the development of autonomic heart rate and blood pressure control, contributing to unfavorable short- and long-term outcomes following FGR.MethodsWe studied 25 preterm FGR and 22 preterm and 19 term appropriate for gestational age (AGA) infants. Preterm neonates were studied on postnatal day 1, and all infants were studied at 1 and 6 months post-term age. To investigate autonomic cardiovascular control, we examined heart rate variability (HRV) and baroreflex sensitivity using spectral power and transfer-function analyses.ResultsPreterm FGR neonates exhibited higher heart rates and reduced HRV compared with preterm AGA controls on postnatal day 1. No significant differences were found between the three groups at 1 or 6 months post-term age.ConclusionPreterm FGR neonates display compromised HRV on postnatal day 1, which may suggest increased vulnerability to circulatory instability. This may predispose these neonates to systemic and cerebral hypoperfusion and increase the risk of long-term neurodevelopmental sequelae. Differences were no longer found at 1 and 6 months post-term age, suggesting that the maturation of autonomic cardiovascular control may be preserved following FGR.