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Heart rate variability in encephalopathic newborns during and after therapeutic hypothermia.

Massaro AN, Govindan RB, Al-Shargabi T, Andescavage NN, Metzler M, Chang T, Glass P, du Plessis AJ - J Perinatol (2014)

Bottom Line: HRV measures were compared between infants with adverse outcome (death or neurodevelopmental impairment at 15 months, n = 10) and those with favorable outcome (survivors without impairment, n = 10).This physiological biomarker may identify infants in need of adjuvant neuroprotective interventions.These findings warrant further investigation in a larger population of infants with HIE.

View Article: PubMed Central - PubMed

Affiliation: 1] Department of Neonatology, Children's National Medical Center, Washington, DC, USA [2] Department of Fetal and Transitional Medicine, Children's National Medical Center, Washington, DC, USA [3] Department of Pediatrics, The George Washington University School of Medicine, Washington, DC, USA.

ABSTRACT

Objective: To evaluate whether heart rate variability (HRV) measures are predictive of neurological outcome in babies with hypoxic ischemic encephalopathy (HIE).

Study design: This case-control investigation included 20 term encephalopathic newborns treated with systemic hypothermia in a regional neonatal intensive care unit. Electrocardiographic data were collected continuously during hypothermia. Spectral analysis of beat-to-beat heart rate interval was used to quantify HRV. HRV measures were compared between infants with adverse outcome (death or neurodevelopmental impairment at 15 months, n = 10) and those with favorable outcome (survivors without impairment, n = 10).

Result: HRV differentiated infants by outcome during hypothermia through post-rewarming, with the best distinction between groups at 24 h and after 80 h of life.

Conclusion: HRV during hypothermia treatment distinguished HIE babies who subsequently died or had neurodevelopmental impairment from intact survivors. This physiological biomarker may identify infants in need of adjuvant neuroprotective interventions. These findings warrant further investigation in a larger population of infants with HIE.

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Related in: MedlinePlus

Heart rate variability (HRV), expressed as relative [A] low-frequency (LF) and [B] high-frequency (HF) power, over time from birth in favorable outcome (open squares) versus adverse outcome (filled triangles) groups. Data is depicted as median (IQR). Number of epochs per comparison and number of patients from whom data were available are shown in the embedded table. Asterisks mark significant differences (p<0.01) between groups after Bonferonni correction.
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Figure 1: Heart rate variability (HRV), expressed as relative [A] low-frequency (LF) and [B] high-frequency (HF) power, over time from birth in favorable outcome (open squares) versus adverse outcome (filled triangles) groups. Data is depicted as median (IQR). Number of epochs per comparison and number of patients from whom data were available are shown in the embedded table. Asterisks mark significant differences (p<0.01) between groups after Bonferonni correction.

Mentions: EEG/EKG monitoring began at a median 11.6 (Range 4.7–40.7) hours of life. Total study duration varied between 20–110 hours (median 90.05 hours). Shorter duration studies were, as expected, present in the infants who died during cooling. Evolution of HRV over time for each outcome group is depicted in Figure 1. LF relative power was lower at nearly all timepoints in infants in the adverse outcome group compared to those with favorable outcome. These differences remained statistically significant (p<0.01) between 18–54 hours (except at 39 hours) and after 80 hours when controlling for multiple comparisons. In contrast, HF relative power was significantly higher in the adverse outcome group at nearly all time points.


Heart rate variability in encephalopathic newborns during and after therapeutic hypothermia.

Massaro AN, Govindan RB, Al-Shargabi T, Andescavage NN, Metzler M, Chang T, Glass P, du Plessis AJ - J Perinatol (2014)

Heart rate variability (HRV), expressed as relative [A] low-frequency (LF) and [B] high-frequency (HF) power, over time from birth in favorable outcome (open squares) versus adverse outcome (filled triangles) groups. Data is depicted as median (IQR). Number of epochs per comparison and number of patients from whom data were available are shown in the embedded table. Asterisks mark significant differences (p<0.01) between groups after Bonferonni correction.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4216618&req=5

Figure 1: Heart rate variability (HRV), expressed as relative [A] low-frequency (LF) and [B] high-frequency (HF) power, over time from birth in favorable outcome (open squares) versus adverse outcome (filled triangles) groups. Data is depicted as median (IQR). Number of epochs per comparison and number of patients from whom data were available are shown in the embedded table. Asterisks mark significant differences (p<0.01) between groups after Bonferonni correction.
Mentions: EEG/EKG monitoring began at a median 11.6 (Range 4.7–40.7) hours of life. Total study duration varied between 20–110 hours (median 90.05 hours). Shorter duration studies were, as expected, present in the infants who died during cooling. Evolution of HRV over time for each outcome group is depicted in Figure 1. LF relative power was lower at nearly all timepoints in infants in the adverse outcome group compared to those with favorable outcome. These differences remained statistically significant (p<0.01) between 18–54 hours (except at 39 hours) and after 80 hours when controlling for multiple comparisons. In contrast, HF relative power was significantly higher in the adverse outcome group at nearly all time points.

Bottom Line: HRV measures were compared between infants with adverse outcome (death or neurodevelopmental impairment at 15 months, n = 10) and those with favorable outcome (survivors without impairment, n = 10).This physiological biomarker may identify infants in need of adjuvant neuroprotective interventions.These findings warrant further investigation in a larger population of infants with HIE.

View Article: PubMed Central - PubMed

Affiliation: 1] Department of Neonatology, Children's National Medical Center, Washington, DC, USA [2] Department of Fetal and Transitional Medicine, Children's National Medical Center, Washington, DC, USA [3] Department of Pediatrics, The George Washington University School of Medicine, Washington, DC, USA.

ABSTRACT

Objective: To evaluate whether heart rate variability (HRV) measures are predictive of neurological outcome in babies with hypoxic ischemic encephalopathy (HIE).

Study design: This case-control investigation included 20 term encephalopathic newborns treated with systemic hypothermia in a regional neonatal intensive care unit. Electrocardiographic data were collected continuously during hypothermia. Spectral analysis of beat-to-beat heart rate interval was used to quantify HRV. HRV measures were compared between infants with adverse outcome (death or neurodevelopmental impairment at 15 months, n = 10) and those with favorable outcome (survivors without impairment, n = 10).

Result: HRV differentiated infants by outcome during hypothermia through post-rewarming, with the best distinction between groups at 24 h and after 80 h of life.

Conclusion: HRV during hypothermia treatment distinguished HIE babies who subsequently died or had neurodevelopmental impairment from intact survivors. This physiological biomarker may identify infants in need of adjuvant neuroprotective interventions. These findings warrant further investigation in a larger population of infants with HIE.

Show MeSH
Related in: MedlinePlus