Baroreceptor reflex sensitivity in human neonates: the effect of postmenstrual age

Andriessen, Peter; Oetomo, Sidarto Bambang; Peters, C. J.; Vermeulen, Barbara; Wijn, Pff Pieter; Blanco, Carlos E.

doi:10.1113/jphysiol.2005.093641

Cited by 91 publications

(90 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Head tilt-up position results in a small transient decrease in BP initiating a neurally mediated compensatory vasoconstriction and increase in heart rate (23). While we did not measure BP in our infants, Andreissen (24) and others have described maturation of baroreceptor reflex sensitivity (BRS) as infants reach term gestation. Thus in our control infants we can assume mature BRS and their HR changes reflect their BRS and autonomic cardiovascular control.…”

Section: Discussionmentioning

confidence: 99%

Autonomic Alterations in Cocaine-Exposed Neonates Following Orthostatic Stress

et al. 2007

View full text Add to dashboard Cite

ABSTRACT:We investigated the effects of prenatal cocaine exposure (PCE) on heart rate (HR) and heart rate variability (HRV) in the presence of orthostatic stress among near-and full-term neonates. PCE infants (n ϭ 21) and controls (n ϭ 23) were enrolled within 120 h of birth. ECG was recorded for an hour during quiet sleep, 30 min in supine position and then 30 min in an inclined position. Linear mixed models were used to analyze HR and HRV in the time domain and wavelet and power spectrum analyses in the frequency domain. PCE infants had tachycardia both before (p ϭ 0.091) and after tilting (p ϭ 0.015), but with a clear interaction between PCE and orthostatic stress (p ϭ 0.049). Compared with controls, PCE infants had a delayed and prolonged reaction to orthostatic stress. There was also a pronounced interaction with regard to log-transformed SDDRR, a measure of HRV (p ϭ 0.049). Controls experienced an instantaneous increase in log (SDDRR) followed by a prompt return to normal levels, while PCE infants had a gradual increase that did not dissipate quickly. Frequency-domain analyses also distinguished between the cocaine-exposed infants and the controls. Results suggest that the effects of PCE on the development of sympathetic and parasympathetic systems could lead to altered cardiovascular function. H eart rate (HR) and heart rate variability (HRV) are increasingly used to detect a variety of pathophysiologic alterations in the autonomic nervous system (ANS) regulation of cardiac control mechanisms (1). Infants who succumb to sudden infant death syndrome have higher HR and reduced HRV compared with other infants; one speculation is that autonomic disturbances may lead to cardiac instability or may indicate ANS alterations with the potential to affect other vital functions (2). Moreover, the circadian range of HR and certain quantities related to blood pressure (BP) are predictors of neonatal cardiovascular events (3). Hence, power spectrum analysis (PSA) of HRV has been used to assess fetal viability and maturity of the ANS (4,5).Cocaine use by pregnant women has continued to be a prevalent public health problem. Prenatal cocaine exposure (PCE) may lead to abruptio placentae, premature delivery, intrauterine growth restriction, congenital malformations, and fetal death (6 -8). However, controversy exists regarding the influences of PCE on the ANS control mechanism and on neonatal cardiovascular function. Some studies (9 -11), have found elevated HR and reduced HRV in infants with PCE. On the other hand, Regalado et al. (12) found reduced HR and increased HRV following PCE, while another study focusing on the nonlinear dynamics of HRV (13) found no significant differences between PCE infants and controls in spectral power distribution, approximate entropy, correlation dimension, or nonlinear predictability. Spectral analyses in particular have not yielded a consensus about the nature of PCEinduced autonomic alterations. Higher HRV was attributed to increased spectral power across all frequency bands in quiet sl...

show abstract

Section: Discussionmentioning

confidence: 99%

Autonomic Alterations in Cocaine-Exposed Neonates Following Orthostatic Stress

et al. 2007

View full text Add to dashboard Cite

show abstract

“…Transfer function analysis (cross-spectral analysis) between SBP and R-R interval series in the LF band (0.04-0.15 Hz) is a useful estimate of baroreflex sensitivity (7,25,39). This methodology was adapted for preterm infants and we refer to previous papers for further details (11,26). Because R-R interval and BP values obtained from fetal sheep are comparable with values found in preterm infants, the same spectral analysis methodology was followed.…”

Section: Spectral Analysis and Transfer Function Analysismentioning

confidence: 99%

“…According to the transfer function method, baroreflex sensitivity was calculated as the value of the transfer function modulus and phase (i.e., gain and delay) between SBP and R-R interval in the LF, considering a coherence ≥ 0.5 (25). The transfer function methodology has been used in several studies of human preterm infants (11,26). Because the values of SBP and R-R intervals obtained from the fetal sheep are comparable with the values found in preterm infants, the same spectral analysis methodology was followed.…”

Section: Baroreflex In Asphyxiated Fetal Sheepmentioning

confidence: 99%

“…Our understanding of the cardiovascular response of the human preterm infant is limited (11,12), and knowledge of fetal baroreflex is mostly based on animal (sheep) models (13,14). There is, however, conflicting evidence on the fetal and postnatal development of baroreceptor reflex function.…”

Section: Introductionmentioning

confidence: 99%

“…Assessment of the baroreflex function (i.e., heart rate-mediated BP control) can be performed through quantification of baroreceptor sensitivity. Baroreceptor sensitivity (ms/mm Hg) may simply be defined as the change in heart rate (or R-R interval) in response to changes in arterial BP and may be estimated from LF cross-spectral analysis of spontaneous fluctuations in R-R intervals and BP (7-10).Our understanding of the cardiovascular response of the human preterm infant is limited (11,12), and knowledge of fetal baroreflex is mostly based on animal (sheep) models (13,14). There is, however, conflicting evidence on the fetal and postnatal development of baroreceptor reflex function.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Heart rate–mediated blood pressure control in preterm fetal sheep under normal and hypoxic–ischemic conditions

et al. 2013

Self Cite

View full text Add to dashboard Cite

Background:The understanding of hypoxemia-induced changes in baroreflex function is limited and may be studied in a fetal sheep experiment before, during, and after standardized hypoxic conditions. Methods: Preterm fetal lambs were instrumented at 102 d gestation (term: 146 d). At 106 d, intrauterine hypoxia-ischemia was induced by 25 min of umbilical cord occlusion (UCO). Baroreflex-related fluctuations were calculated at 30-min intervals during the first week after UCO by transfer function (crossspectral) analysis between systolic blood pressure (SBP) and R-R interval fluctuations, estimated in the low-frequency (LF, 0.04-0.15 Hz) band. LF transfer gain (baroreflex sensitivity) and delay (s) reflect the baroreflex function. results: Baseline did not differ in LF transfer gain and delay between controls and the UCO group. In controls, LF gain showed postnatal increase. By contrast, LF gain gradually decreased in the UCO group, resulting in significantly lower values 4-7 d after UCO. In the UCO group, LF delay increased and differed significantly from controls. conclusion: Our results show that intrauterine hypoxiaischemia results in reduced baroreflex sensitivity over a period of 7 d, indicating limited efficacy to buffer BP changes by adapting heart rate. Cardiovascular dysregulation may augment already present cerebral damage after systemic hypoxiaischemia in the reperfusion period.P reterm infants have a higher incidence of neurological morbidity and mortality as compared with term infants (1). Neurological sequelae in preterm infants may be the consequence of hypoxia-ischemia during fetal and early postnatal life (2). Hemodynamic factors during hypoxia-ischemia and the posthypoxia-ischemia reperfusion phase contribute considerably to these neurological disorders (3). To ensure adequate blood flow to organs throughout the body, including the brain, blood pressure (BP) is controlled by baroreflex and chemoreflex mechanisms. Under normoxemia, the baroreflex stabilizes perfusion pressure in the face of disturbances of circulatory homeostasis by adapting heart rate, myocardial contraction, and vascular resistance. A poorly developed baroreflex function could contribute to BP instabilities, which may lead to impaired cerebral perfusion or hemorrhage (4). A better understanding of the dynamics underlying the control mechanisms regulating BP may be useful to improve diagnosis of these disorders.Low-frequency (LF) fluctuations in arterial BP with a wavelength of approximately 10 s (also called Mayer waves) have historically been attributed to baroreflex activity (5). The oscillations are assumed to be caused by a feedback control and mediated through the sympathetic and parasympathetic innervations of the baroreflex (6). Assessment of the baroreflex function (i.e., heart rate-mediated BP control) can be performed through quantification of baroreceptor sensitivity. Baroreceptor sensitivity (ms/mm Hg) may simply be defined as the change in heart rate (or R-R interval) in response to changes in arterial BP and may be e...

show abstract

Cardiovascular Physiology in Premature and Term Neonates

Singh¹

2021

Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care

View full text Add to dashboard Cite

Baroreceptor reflex sensitivity in human neonates: the effect of postmenstrual age

Cited by 91 publications

References 35 publications

Autonomic Alterations in Cocaine-Exposed Neonates Following Orthostatic Stress

Autonomic Alterations in Cocaine-Exposed Neonates Following Orthostatic Stress

Heart rate–mediated blood pressure control in preterm fetal sheep under normal and hypoxic–ischemic conditions

Cardiovascular Physiology in Premature and Term Neonates

Contact Info

Product

Resources

About