Impact of Subarachnoid Hemorrhage on the Cardiac Autonomic Function During Rehabilitation in Children After Severe
Gilad Sorek1, Sharon Shaklai2, Isabelle Gagnon3,4
1Department of Physical Therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Children with traumatic subarachnoid hemorrhage (tSAH) after severe traumatic brain injury (TBI) show impaired cardiac autonomic control system (CACS) function. This reduced heart rate variability (HRV) persists during subacute rehabilitation, highlighting a potential cardiac risk.
Area of Science:
- Pediatric Neurology
- Cardiology
- Trauma Research
Background:
- Severe traumatic brain injury (TBI) can impact multiple physiological systems in children.
- Cardiac autonomic control system (CACS) function, assessed via heart rate variability (HRV), is crucial for cardiovascular health.
- The specific effects of traumatic subarachnoid hemorrhage (tSAH) on CACS in pediatric TBI survivors are not well-established.
Purpose of the Study:
- To investigate the impact of tSAH on CACS function in children during subacute rehabilitation after severe TBI.
- To compare HRV parameters between pediatric TBI patients with and without tSAH.
Main Methods:
- A cohort of 33 children (8-18 years) with severe TBI were assessed 42 days post-injury.
- Participants were divided into a tSAH group (n=6) and a non-tSAH group (n=27).
- Heart rate variability (HRV) was measured using standard deviation of the N-N interval (SDNN) and root mean square of successive differences (RMSSD) at rest, with a follow-up assessment 8 weeks later.
Main Results:
- The tSAH group exhibited significantly lower SDNN and RMSSD values compared to the non-tSAH group (p=0.005 and p=0.004, respectively).
- These differences in HRV remained significant at the 8-week follow-up assessment (p=0.035 for SDNN, p=0.008 for RMSSD).
- No significant differences were found in demographic, functional, or injury severity characteristics between the groups.
Conclusions:
- Pediatric TBI patients with co-occurring tSAH demonstrate poorer cardiac autonomic control system function during subacute rehabilitation.
- Reduced HRV in tSAH patients may indicate an increased risk for cardiac complications.
- Clinical teams should consider the influence of tSAH on cardiovascular health in pediatric TBI survivors; further research with larger cohorts is recommended.
Abstract:
This study aimed to investigate the impact of traumatic subarachnoid hemorrhage (tSAH) on cardiac autonomic control system (CACS) function in children after severe traumatic brain injury (TBI) during the subacute rehabilitation period. Thirty-three participants, 8-18 years of age, 42 (14-149) days after severe TBI at the beginning of the subacute rehabilitation, were included in the study. Six participants were diagnosed with tSAH during acute medical care (tSAH group). Heart rate variability (HRV) was assessed by the standard deviation of the N-N interval (SDNN) and the square root of the mean square differences of successive R-R interval (RMSSD) using a Polar RS800CX device while sitting at rest for 5 min. A second assessment was performed 8 weeks later. No significant difference between the tSAH and non-tSAH groups were found in the demographic and functional characteristics or injury severity. However, in comparison to the non-tSAH group, the tSAH group had lower SDNN (23.9 [10.5-47.3] vs. 43.9 [21.8-118.8], respectively; p = 0.005) and RMSSD values (11.8 [5.9-24.5] vs. 29.6 [8.9-71.7], respectively; p = 0.004). Neither group demonstrated changes in HRV values at rest in the second assessment, whereas the significant difference in SDNN (p = 0.035) and RMSSD (p = 0.008) remained. Children diagnosed with SAH after severe TBI presented poorer CACS function during the subacute rehabilitation. Given that reduced HRV values may be a marker for potential heart disease, the medical team should be aware of the influence of existing tSAH. Future studies with larger sample sizes and longer follow-up periods are warranted to further investigate this topic. ClinicalTrials.gov number: NCT03215082.
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