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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

Area under the receiver operating curve (AUC) values plotted over time for ability of relative [A] low-frequency (LF) and [B] high-frequency (HF) power to discriminate between outcome groups. Dashed reference line is provided at the AUC value of 0.7. Note the relative peaks at 24 hours and after 80 hours of life.
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Figure 2: Area under the receiver operating curve (AUC) values plotted over time for ability of relative [A] low-frequency (LF) and [B] high-frequency (HF) power to discriminate between outcome groups. Dashed reference line is provided at the AUC value of 0.7. Note the relative peaks at 24 hours and after 80 hours of life.

Mentions: Area under the receiver operating curve for discrimination of outcome group is plotted over time in Figure 2. The highest AUC values for LF relative power were demonstrated around 24 hours of life and after 80 hours of life. This signifies two key periods of vulnerability, during which time the separation between outcome groups became most evident. For HF relative power, a similar peak AUC was observed around 24 hours of life, while the second increase in AUC was observed after 96 hours of life. Selected cutpoints at key time periods of peak AUC and their respective sensitivities and specificities are presented in Table 2.


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)

Area under the receiver operating curve (AUC) values plotted over time for ability of relative [A] low-frequency (LF) and [B] high-frequency (HF) power to discriminate between outcome groups. Dashed reference line is provided at the AUC value of 0.7. Note the relative peaks at 24 hours and after 80 hours of life.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 2: Area under the receiver operating curve (AUC) values plotted over time for ability of relative [A] low-frequency (LF) and [B] high-frequency (HF) power to discriminate between outcome groups. Dashed reference line is provided at the AUC value of 0.7. Note the relative peaks at 24 hours and after 80 hours of life.
Mentions: Area under the receiver operating curve for discrimination of outcome group is plotted over time in Figure 2. The highest AUC values for LF relative power were demonstrated around 24 hours of life and after 80 hours of life. This signifies two key periods of vulnerability, during which time the separation between outcome groups became most evident. For HF relative power, a similar peak AUC was observed around 24 hours of life, while the second increase in AUC was observed after 96 hours of life. Selected cutpoints at key time periods of peak AUC and their respective sensitivities and specificities are presented in Table 2.

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