Assessment of spontaneous baroreflex sensitivity in neonates

Drouin, Emmanuel; Gournay, Véronique; Calamel, Jean; Mouzard, A; Rozé, Jean‐Christophe

doi:10.1136/fn.76.2.f108

Cited by 53 publications

(34 citation statements)

References 14 publications

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“…Overall, studies in human neonate, mainly of HR changes in response to spontaneous changes in blood pressure or small changes using tilt-tables over short periods of time, are consistent with reduced sensitivity of the baroreflex with younger postconceptional age (1,14,18,28). Animal studies investigating the immediate effects of blood pressure changes on HR have variably shown decreased baroreflex sensitivity in the preterm fetus compared with later in gestation (42) or no significant change in sensitivity with increased gestation (16,26).…”

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confidence: 81%

Is baroreflex control of sympathetic activity and heart rate active in the preterm fetal sheep?

Booth

Malpas²,

Barrett³

et al. 2009

American Journal of Physiology-Regulatory, Integrative and Comp

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confidence: 81%

Is baroreflex control of sympathetic activity and heart rate active in the preterm fetal sheep?

Booth

Malpas²,

Barrett³

et al. 2009

American Journal of Physiology-Regulatory, Integrative and Comp

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“…Because baroreflex sensitivity specifies the ratio between changes in R-R interval time and changes in SBP (ms/mm Hg), Finapres could be useful in clinical research to quantify this measure. Spontaneous baroreflex sensitivity has been assessed using (the wrist method) Finapres in neonates by time-domain analysis (15). In addition, this noninvasive technique enables use of cross-spectral analysis (transfer function analysis) of heart rate and BP fluctuations (13).…”

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confidence: 99%

Noninvasive Assessment of Blood Pressure Variability in Preterm Infants

et al. 2004

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The feasibility of measuring blood pressure (BP) variability by a noninvasive beat-to-beat finger arterial BP device (Finapres) was assessed in preterm infants. By application of the finger cuff around the infant's wrist, time and frequency domain (spectral power) analysis of noninvasive beat-to-beat BP signals were compared with intra-arterial measurements. A fast Fourier Transform was used to compute the spectral power density from 128-s periods. The low-frequency band (LF; 0.04 -0.15 Hz) is partly associated with baroreflex activity. The high-frequency band (HF; 0.4 -1.5 Hz) is associated with respiratory activity. In eight subjects above 1000 g, reliable signals could be obtained. We observed a high correlation between noninvasive and intraarterial beat-to-beat systolic BP values (mean r value Ϯ SD, 0.87 Ϯ 0.11), with a gain close to 1 (mean gain Ϯ SD, 1.0 Ϯ 0.4 mm Hg/mm Hg). Finapres estimated beat-to-beat systolic BP changes more accurately than diastolic values. We found a very high amount of linear coupling, expressed as coherence function, between the power spectra of noninvasive and intra-arterial systolic BP measurements. For systolic BP, the (pooled) group mean Ϯ SEM coherence values were 0.93 Ϯ 0.00 and 0.91 Ϯ 0.01 for LF and HF fluctuations, respectively (NS). The wrist method of Finapres in neonates has limited value in estimating absolute BP but is useful in a clinical research situation, where identification of beat-to-beat changes in systolic BP is more important. Finapres (FINger Arterial PRESsure) is a noninvasive blood pressure (BP) method that is based on the volume-clamp principle (1). The device is based on a photoplethysmographic system applied to the finger and provides a continuous beatto-beat waveform. Several studies of Finapres have been reported and have shown good agreement with intra-arterial measured BP, in both adults and children (2-4). Despite abundant literature about the application of Finapres in adults, very little is known in neonates. Drouin et al. (5) published in 1997 about the accuracy of Finapres measurements in the neonate. Because no appropriately sized cuff exists for neonates, Drouin placed the finger cuff around the wrist of the baby. Absolute Finapres BP values were compared with intraarterial BP for selected periods of 5 s, and it was concluded that both methods gave similar results. However, no information was given about the accuracy of measuring BP fluctuations over longer periods of time. We do know from studies in adults, however, that Finapres may overestimate the lowfrequency (LF) fluctuation (6). The reliability of Finapres to produce frequency domain analysis in neonates has not been assessed. The aim of this study was to determine 1) the accuracy of Finapres in measuring BP absolute values and beat-to-beat changes and 2) the accuracy of Finapres in studying BP variability by frequency domain analysis. METHODSThe study was performed in 12 preterm infants (gestational age, 26 -33 wk; birth weight, 750 -2215 g) whose intensive

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“…[2][3][4] The baroreflex becomes functional late in gestation, and its sensitivity then increases gradually, but in the neonate, it is still much below the level that has been reported for young adults. 5,6 There are no data in the literature about cardiovagal autonomic function between infancy and young adulthood. This lack of information is surprising, because this is an important period of life, when children increase their physical activities, face intellectual challenges at school, and undergo profound hormonal changes associated with puberty.…”

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Maturation of Cardiovagal Autonomic Function From Childhood to Young Adult Age

et al. 2004

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Background-Cardiovagal autonomic control declines with age in adult subjects, which is related in part to increasing stiffness of the barosensory vessel wall. It is not known, however, whether autonomic function changes with age in children. Methods and Results-We studied 137 healthy subjects divided into 4 age groups: group 1, 7 to 14 years; group 2, 11 to 14 years; group 3, 15 to 18 years; and group 4, 19 to 22 years. Brachial artery pressure was measured by sphygmomanometry and continuous radial artery pressure and carotid artery pulse pressure (⌬P) by applanation tonometry. The R-R interval was derived from the ECG. Autonomic function was assessed by spontaneous sequence and frequency-domain indices, which indicate the extent of coupling between fluctuations in heart rate and systolic pressure. Carotid artery diastolic diameter (DD) and pulsatile distension (⌬D) were measured by echo wall tracking; carotid compliance coefficient (CC) was defined as ⌬D/⌬P and distensibility coefficient as 2⌬D/DD · ⌬P. , with no significant changes afterward. CC and DC were inversely proportional to age (rϭϪ0.49 and Ϫ0.62, respectively, PϽ0.001). The efficiency of neural integrative mechanisms, estimated as the ratio of spontaneous indices and CC, more than doubled from group 1 to group 3. Spontaneous indices were linearly related to measures of cardiac vagal activity. Conclusions-The increase in spontaneous indices from early childhood to adolescence, despite gradual stiffening of the carotid artery, may indicate improved cardiovagal autonomic function, which is most likely a result of maturation of neural mechanisms, attaining peak level at adolescence.

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Assessment of spontaneous baroreflex sensitivity in neonates

Cited by 53 publications

References 14 publications

Is baroreflex control of sympathetic activity and heart rate active in the preterm fetal sheep?

Is baroreflex control of sympathetic activity and heart rate active in the preterm fetal sheep?

Noninvasive Assessment of Blood Pressure Variability in Preterm Infants

Maturation of Cardiovagal Autonomic Function From Childhood to Young Adult Age

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