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In infants with congenital heart disease autonomic dysfunction is associated with pre-operative brain injury
Sarah D Schlatterer1,2,3, Rathinaswamy B Govindan4,5, Jonathan Murnick6,7
1Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA. sschlatt@childrensnational.org.
Insights
Impaired autonomic function, measured by heart rate variability (HRV), in neonates with critical congenital heart disease (CHD) is linked to pre-operative brain injury. Time-domain HRV metrics show promise as biomarkers for this risk.
Area of Science:
- Neonatal Neurology
- Pediatric Cardiology
- Autonomic Neuroscience
Background:
- Brain injury is a frequent complication in neonates with critical congenital heart disease (CHD).
- Impaired autonomic development, assessed via heart rate variability (HRV), is linked to brain injury in other neonatal populations.
Purpose of the Study:
- To investigate the association between early neonatal HRV and pre-operative brain injury in infants with critical CHD.
Main Methods:
- HRV was evaluated in infants with critical CHD within 24 hours of cardiac ICU admission using time-domain and frequency-domain metrics.
- Pre-operative brain MRI was used to assess brain injury.
- Spearman's correlation was employed to analyze the association between HRV and brain injury.
Main Results:
- 34 infants were enrolled; 13 showed MRI evidence of brain injury.
- Time-domain HRV metrics (RMS 1 and RMS 2) were inversely correlated with pre-operative brain injury.
Conclusions:
- Early neonatal time-domain HRV metrics are associated with pre-operative brain injury in infants with critical CHD.
- These findings suggest HRV may be a valuable biomarker for brain injury risk in this population.
Background:
Brain injury is a serious and common complication of critical congenital heart disease (CHD). Impaired autonomic development (assessed by heart rate variability (HRV)) is associated with brain injury in other high-risk neonatal populations.
Objective:
To determine whether impaired early neonatal HRV is associated with pre-operative brain injury in CHD.
Methods:
In infants with critical CHD, we evaluated HRV during the first 24 h of cardiac ICU (CICU) admission using time-domain (RMS 1, RMS 2, and alpha 1) and frequency-domain metrics (LF, nLF, HF, nHF). Pre-operative brain magnetic resonance imaging (MRI) was scored for injury using an established system. Spearman's correlation coefficient was used to determine the association between HRV and pre-operative brain injury.
Results:
We enrolled 34 infants with median birth gestational age of 38.8 weeks (IQR 38.1-39.1). Median postnatal age at pre-operative brain MRI was 2 days (IQR 1-3 days). Thirteen infants had MRI evidence of brain injury. RMS 1 and RMS 2 were inversely correlated with pre-operative brain injury.
Conclusions:
Time-domain metrics of autonomic function measured within the first 24 h of admission to the CICU are associated with pre-operative brain injury, and may perform better than frequency-domain metrics under non-stationary conditions such as critical illness.
Impact:
Autonomic dysfunction, measured by heart rate variability (HRV), in early transition is associated with pre-operative brain injury in neonates with critical congenital heart disease. These data extend our earlier findings by providing further evidence for (i) autonomic dysfunction in infants with CHD, and (ii) an association between autonomic dysfunction and brain injury in critically ill neonates. These data support the notion that further investigation of HRV as a biomarker for brain injury risk is warranted in infants with critical CHD.
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