Autonomic nervous system maturation in the premature extrauterine milieu

Mulkey, Sarah B.; Govindan, Rathinaswamy B.; Hitchings, Laura; Al-Shargabi, Tareq; Herrera, Nicole; Swisher, Christopher; Eze, Augustine; Russo, Stephanie; Schlatterer, Sarah D.; Jacobs, Marni; McCarter, Robert; Kline, Alex J.; Maxwell, G. Larry; Baker, Robin; Plessis, Adré J. du

doi:10.1038/s41390-020-0952-0

Cited by 14 publications

(6 citation statements)

References 32 publications

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“…In low-risk samples of premature infants, such as the population involved in the present study, the association between duration of preterm extrauterine maturation and ANS development was not significant before the term-corrected age [ 9 ]. Thus, in stable populations of preterm infants, with no additional comorbidities other than prematurity, we can presume that fluctuations in the HR could be mainly determined by environmental intervening factors.…”

Section: Introductionmentioning

confidence: 99%

Maternal Singing but Not Speech Enhances Vagal Activity in Preterm Infants during Hospitalization: Preliminary Results

Filippa

Nardelli

Casa³

et al. 2022

Children

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Background: Early parental interventions in the Neonatal Intensive Care Units (NICUs) have beneficial effects on preterm infants’ short and long-term outcomes. The aim of this study was to investigate the effects of Early Vocal Contact (EVC)—singing and speaking—on preterm infants’ vagal activity and autonomic nervous system (ANS) maturation. Methods: In this multi-center randomized clinical trial, twenty-four stable preterm infants, born at 25–32 weeks gestational age, were randomized to either the EVC group or control group, where mothers did not interact with the babies but observed their behavior. Heart Rate Variability (HRV) was acquired before intervention (pre-condition), during vocal contact, and after it (post condition). Results: No significant effect of the vocal contact, singing and speaking, was found in HRV when the intervention group was compared to the control group. However, a significant difference between the singing and the pre and post conditions, respectively, preceding and following the singing intervention, was found in the Low and High Frequency power nu, and in the low/high frequency features (p = 0.037). By contrast, no significant effect of the speaking was found. Conclusions: Maternal singing, but not speaking, enhances preterm infants’ vagal activity in the short-term, thus improving the ANS stability. Future analyses will investigate the effect of enhanced vagal activity on short and long-term developmental outcomes of preterm infants in the NICU.

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Section: Introductionmentioning

confidence: 99%

Maternal Singing but Not Speech Enhances Vagal Activity in Preterm Infants during Hospitalization: Preliminary Results

Filippa

Nardelli

Casa³

et al. 2022

Children

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“…The ANS matures during gestation (Leppanen & Nelson, 2009) and is a crucial part of the neonatal transition from the womb to the external environment, enabling infants' vital functions, like regular heart rate, breathing, feeding, and maintaining stable body temperature (Mulkey et al., 2021). However, infants still depend on their parents for basic needs (Beebe & Lachmann, 2015; Porges & Furman, 2011).…”

Section: Three Levels Of Communication In Infancymentioning

confidence: 99%

An integrative model of parent‐infant communication development

Lipschits,

Geva

2024

Child Dev Perspectives

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Communication is commonly viewed as connecting people through conscious symbolic processes. Infants have an immature communication toolbox, raising the question of how they form a sense of connectedness. In this article, we propose a framework for infants' communication, emphasizing the subtle unconscious behaviors and autonomic contingent signals that convey drives, emotions, and a sense of connection, facilitating the formation of primal social bonds. Our developmental model emphasizes the importance of diverse modes of communication and their interplay in social interactions during infancy. The framework leverages three levels of communication—autonomic, behavioral, and symbolic—and their different maturational pathways. Initially, infants' social communication relies on autonomic responses and a dynamic behavioral repertoire, which evolve during the first year of life, supporting the emergence of symbolic communication. This extended communication framework highlights infants' role as proactive communicating agents and allows for tracing communicative developmental cascades back to their origins.

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“…Postnatal ANS development and maturation, measured by HRV, are correlated with increasing GA and postnatal age [36][37][38][39][40][41][42][43][44]. In a prospective longitudinal study, Mulkey and colleagues [45] analyzed HRV to study ANS activity of 100 preterm infants (mean GA 31.9 weeks). Analysis of HRV features demonstrated both sympathetic and parasympathetic tones were lowest among infants born most preterm and when compared to term infants.…”

Section: Ans Function Continuum In Preterm Newbornsmentioning

confidence: 99%

Pulmonary Resilience: Moderating the Association between Oxygen Exposure and Pulmonary Outcomes in Extremely Preterm Newborns

2022

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Bronchopulmonary dysplasia (BPD) is a chronic lung disease of infancy associated with high morbidity and mortality. Although most prevalent following extremely preterm birth, BPD is diagnosed at 36 weeks post-menstrual age, when the disease trajectory is underway, and long-term physiological implications may be irreversible. There is an urgent and unmet need to identify how early exposures can be modified to decrease the risk of developing BPD before disease progression becomes irreversible. Extremely preterm newborns encounter a paradox at birth: oxygen is a life-sustaining component of ex utero life yet is undeniably toxic. Attempts at minimizing supplemental oxygen exposure by targeting lower oxygen saturations appear to decrease BPD but may increase mortality. Given the potential association between lower oxygen saturations and increased mortality, practice guidelines favor targeting higher saturations. This uniformly increases oxygen exposure, prompting a cascade of pathogenic mechanisms implicated in BPD development. In this review, we introduce the concept of pulmonary resilience: a homeostatic process driven by the autonomic nervous system (ANS) as a moderator of physiologic stress that when functional, could inform successful environmental adaptation following extremely preterm birth. We hypothesize that infants with early-life ANS dysfunction require a higher oxygen dose for survival; conversely, oxygen exposure could be safely limited in infants with more robust early-life ANS function, an indicator of pulmonary resilience. Characterizing the pulmonary resilience continuum to guide individualized supplemental oxygen dosing may reduce morbidity and mortality in this growing population of extremely preterm infants at risk for BPD.

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Autonomic nervous system maturation in the premature extrauterine milieu

Cited by 14 publications

References 32 publications

Maternal Singing but Not Speech Enhances Vagal Activity in Preterm Infants during Hospitalization: Preliminary Results

Maternal Singing but Not Speech Enhances Vagal Activity in Preterm Infants during Hospitalization: Preliminary Results

An integrative model of parent‐infant communication development

Pulmonary Resilience: Moderating the Association between Oxygen Exposure and Pulmonary Outcomes in Extremely Preterm Newborns

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