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Published on: June 5, 2019
Heart Rate Variability as a Feeding Intervention Outcome Measure in the Preterm Infant
Britt F Pados1, Suzanne M Thoyre, George J Knafl
1School of Nursing, Boston College, Chestnut Hill, Massachusetts (Dr Pados); and School of Nursing, University of North Carolina at Chapel Hill (Drs Thoyre and Knafl and Mr Nix).
Insights
Heart rate variability (HRV) can indicate stress in preterm infants during feeding. A specific HRV measure, SD12, showed greater sensitivity to stress than standard vital signs, suggesting its potential for evaluating feeding interventions.
Area of Science:
- Neonatal Physiology
- Cardiovascular Regulation
- Infant Nutrition
Background:
- Feeding interventions for preterm infants aim to minimize physiologic stress and promote growth.
- Heart rate variability (HRV) offers a noninvasive method to assess physiologic stress during feeding.
- Evaluating HRV's efficacy in feeding interventions is crucial for optimizing infant care.
Purpose of the Study:
- To determine if HRV is a sensitive indicator of physiologic stress compared to standard outcomes in preterm infants during feeding.
- To assess the utility of HRV in evaluating the effectiveness of different feeding approaches.
Main Methods:
- A secondary analysis of a within-subjects, cross-over study involving 14 preterm infants (<35 weeks postmenstrual age).
- Comparison of usual care feeding with a gentle, coregulated (CoReg) feeding approach.
- Calculation of HRV indices from electrocardiogram data and comparison with standard physiologic outcomes (SpO2, RR, apnea, HR, bradycardia) using linear mixed modeling.
Main Results:
- Infants receiving CoReg feeding exhibited fewer apneic events and higher respiratory rates (RR).
- No significant differences were observed in SpO2, HR, bradycardia, or high-frequency HRV power between feeding groups.
- The SD12 HRV index, indicating heart rate randomness, was significantly higher in the usual care group, suggesting elevated stress.
Conclusions:
- The HRV index SD12 demonstrated higher sensitivity to stress than standard measures like SpO2, HR, and bradycardia.
- Further research is needed to explore the clinical utility of HRV, particularly nonlinear indices like SD12, for assessing feeding outcomes in preterm infants.
Background:
Feeding interventions for preterm infants aim to reduce the physiologic stress of feeding to promote growth. Heart rate variability (HRV) is a potential noninvasive measure of physiologic stress that may be useful for evaluating efficacy of feeding interventions.
Purpose:
To evaluate whether HRV is a sensitive measure of physiologic stress compared with standard physiologic outcomes in the context of a feeding intervention study.
Methods:
This was a secondary analysis of a within-subjects, cross-over design study comparing usual care feeding with a gentle, coregulated (CoReg) feeding approach in 14 infants born less than 35 weeks' postmenstrual age. HRV indices were calculated from electrocardiogram data and compared with standard physiologic outcomes, including oxygen saturation (Spo2), respiratory rate (RR), apnea, heart rate (HR), and bradycardia. Data were analyzed using linear mixed modeling.
Results:
Infants fed using the CoReg approach had fewer apneic events and higher RR, suggesting they were able to breathe more during feeding. No statistically significant differences were found in SpO2, HR, bradycardia, or high frequency power (the most commonly reported measure of HRV). Infants fed using the usual care approach had significantly higher SD12, a measure of HRV indicating randomness in the HR, which is a potential indicator of elevated stress.
Implications For Practice:
SD12 was more sensitive to stress than SpO2, HR, and bradycardia. The utility of HRV as a measure of feeding outcomes in clinical practice needs further exploration.
Implications For Research:
Further exploration of HRV as an intervention outcome measure is needed, particularly evaluating nonlinear indices, such as SD12.
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