Heart Rate Variability as a Predictor of Region-Specific Brain Injury in Neonates with Perinatal Asphyxia: A...

Area of Science:

• Neonatal Neurology
• Biomarker Discovery
• Medical Technology

Background:

• Moderate-to-severe hypoxic-ischemic encephalopathy (HIE) poses significant neurological risks for neonates in low- and middle-income countries (LMICs).
• Therapeutic hypothermia (TH) is used, but improved risk stratification is needed.
• Accessible, real-time biomarkers are crucial for guiding neuroprotective care in LMICs.

Purpose of the Study:

• To evaluate heart rate variability (HRV) metrics for predicting brain injury.
• To assess HRV's capacity in neonates with HIE undergoing TH in an LMIC.
• To correlate HRV with magnetic resonance imaging (MRI)-detected brain injury.

Main Methods:

• Prospective observational study of 87 neonates with HIE treated with TH in Colombia.
• HRV recorded during TH, rewarming, and post-rewarming.
• Brain MRI within the first week, scored using the Rutherford system.
• Analysis using ROC curves and logistic regression.

Main Results:

• Lower low-frequency (LF) and high-frequency (HF) powers were linked to MRI abnormalities.
• LF power during rewarming showed high predictive accuracy (AUC = 0.90).
• HF power during the first 24 hours was also predictive (AUC = 0.80).
• Reduced LF power correlated with white matter and basal ganglia injury.

Conclusions:

• HRV is a promising and accessible biomarker for regional brain injury in neonates with HIE.
• LF power during rewarming is particularly effective for risk stratification.
• This finding supports using HRV to guide neuroprotection in LMICs.