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Published on: January 27, 2023
Heart Rate Variability as a Prognostic Tool for Gastroschisis Infants in the Neonatal Intensive Critical Unit
Chioma Moneme1, Sherry L Kausch2, Briana M Belmonte3
1Department of Surgery, The University of Virginia, Charlottesville, Virginia.
Insights
Infants with gastroschisis, a congenital defect, show decreased heart rate variability (HRV). This heart rate characteristic (HRC) can predict complications in complex gastroschisis cases, impacting recovery time.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Critical Care Medicine
Background:
- Gastroschisis is a common congenital abdominal wall defect with increasing incidence.
- It leads to extruded abdominal contents and delayed intestinal motility.
- Abnormal heart rate characteristics (HRCs), like reduced variability, are linked to sepsis-induced inflammation in preterm infants.
Purpose of the Study:
- To investigate if infants with gastroschisis exhibit decreased heart rate variability (HRV) post-birth.
- To determine if HRV can serve as a physiomarker for predicting gastroschisis outcomes.
- To explore the association between HRCs and intestinal inflammation in complex gastroschisis.
Main Methods:
- Analysis of heart rate data and clinical variables from infants with gastroschisis (2009-2020).
- Inclusion of 47 infants with available data for the study period.
- Comparison of clinical characteristics between simple and complex gastroschisis subcategories.
Main Results:
- Infants with complex gastroschisis demonstrated reduced HRV after birth.
- Abnormal HRCs were observed early in infants with sepsis and necrotizing enterocolitis.
- Decreased HRV correlated with the development of gastroschisis complications.
Conclusions:
- Reduced HRV is associated with complex gastroschisis.
- Complex gastroschisis cases result in prolonged time to full enteral feeding and total parenteral nutrition.
- Abnormal HRV may indicate increased risk and severity in gastroschisis infants.
Objective:
Gastroschisis is the most common congenital abdominal wall defect, with an increasing incidence. It results in extrusion of abdominal contents with associated delayed intestinal motility. Abnormal heart rate characteristics (HRCs) such as decreased variability occur due to the inflammatory response to sepsis in preterm infants. This study aimed to test the hypothesis that infants with gastroschisis have decreased heart rate variability (HRV) after birth and that this physiomarker may predict outcomes.
Study Design:
We analyzed heart rate data from and clinical variables for all infants admitted with gastroschisis from 2009 to 2020.
Results:
Forty-seven infants were admitted during the study period and had available data. Complex gastroschisis infants had reduced HRV after birth. For those with sepsis and necrotizing enterocolitis, abnormal HRCs occurred early in the course of illness.
Conclusion:
Decreased HRV was associated with complex gastroschisis. Infants in this group experienced complications that prolonged time to full enteral feeding and time on total parenteral nutrition.
Key Points:
· Infants with gastroschisis can be classified into two subcategories, simple and complex disease.. · Those with complex disease often require prolonged stays in the neonatal intensive care unit and costly hospitalizations. We hypothesized that infants with complex gastroschisis are more likely to have abnormal HRC due to intestinal inflammation.. · In this study, we identified associations between abnormal HRV, heart rate characteristicHRC, and the development of gastroschisis complications. Additionally, we described differences in clinical characteristics between infants with complex versus simple gastroschisis..
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