Heart rate variability in preterm brain-injured and very-low-birth-weight infants

Citation
Bd. Hanna et al., Heart rate variability in preterm brain-injured and very-low-birth-weight infants, BIOL NEONAT, 77(3), 2000, pp. 147-155
Citations number
31
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Medical Research General Topics
Journal title
BIOLOGY OF THE NEONATE
ISSN journal
0006-3126 → ACNP
Volume
77
Issue
3
Year of publication
2000
Pages
147 - 155
Database
ISI
SICI code
0006-3126(2000)77:3<147:HRVIPB>2.0.ZU;2-R
Abstract
Heart rate variability (HRV) reflects the complex interplay of the sympathe tic and parasympathetic innervation of the heart. Developmental maturation of the fetus and newborn results in predictable alterations in the neural c ardiac control of heart rate. Furthermore, patterns of HRV are closely corr elated to clinical outcome in several pathologic situations. The first aim of this study was to characterize the maturational patterns of HRV in a gro up of developmentally at-risk newborns (those with severe hemorrhagic or is chemic brain injury and extremely immature, low-birth-weight infants). Seco ndly, we sought to determine whether a correlation exists between HRV and l ength of hospital stay, diagnosis of cerebral palsy, and neurodevelopmental test scores at 1-year corrected age. Time domain indices of HRV were compu ted longitudinally from 32 to 37 weeks of corrected gestational age in 19 v ery low birth weight, preterm infants. Among the 19 infants studied, 7 infa nts had no evidence of brain injury, 7 infants had periventricular leukomal acia (PVL), 3 infants had grade III/IV intraventricular hemorrhage (IVH), a nd 2 infants had both IVH and PVL. Neurologic injuries were documented usin g ultrasound and neurodevelopmental progress was followed through 1 year of corrected gestational age. A multivariate repeated measures analysis was p erformed to determine the relationship between the type of perinatal brain injury and neurodevelopmental status at 1 year of corrected gestational age . The type of perinatal brain injury was highly correlated to specific patt erns of HRV with multivariate regression models producing adjusted r(2) val ues ranging from 0.63 to 0.99. The type of perinatal brain injury was highl y correlated to the developmental outcome measures (p < 0.0000) with PVL pa tients having the lowest neurodevelopmental scores, IVH patients having the highest scores, and noninjured infants having midrange, grossly normal val ues. Using ANOVA, HRV was correlated to outcome, but individual comparisons revealed statistical significance only for the noninjured group (p < 0.04) . However, multivariate models, which characterized outcome within each bra in injury group, were highly significant (adjusted r(2) ranged from 0.23 to 0.89). In summary, the type of perinatal brain injury determined the patte rn of HRV and HRV was highly correlated to length of hospital stay and neur odevelopmental function assessed at 1 year of corrected gestational age. Co pyright (C) 2000 Karger AG, Basel.