Continuous monitoring of heart rate variability in preterm infants

Prietsch, Viola; Knoepke, Uwe; Obladen, Michael

doi:10.1016/0378-3782(94)90153-8

Cited by 25 publications

(15 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A further important clinical concern is that because brain stem nuclei, including the dorsal motor nucleus of the vagus and the nucleus ambiguus, have a central role in cardiac control (12,13), antenatal asphyxial neural injury may itself lead to a confounding loss of FHRV (39,47). This concept is supported by reports of reduced FHRV in preterm infants with evidence of cerebral injury or suppression (38,41).…”

mentioning

confidence: 74%

“…The different responses compared with near term likely reflects the greater anaerobic reserves of the preterm fetus, which permits this degree of energy expenditure at such a critical time (49). The subsequent reduction in FHRV corresponds to the cessation of activity and may also reflect hypoxic suppression of brain stem activity (41) and changes in parasympathetic activity (21). This suppression of FHRV by asphyxia was not maintained when cord occlusion was continued to a near-terminal degree.…”

Section: Discussionmentioning

confidence: 95%

See 1 more Smart Citation

Fetal heart rate variability and brain stem injury after asphyxia in preterm fetal sheep

George¹,

Gunn²,

Westgate³

et al. 2004

American Journal of Physiology-Regulatory, Integrative and Comp

View full text Add to dashboard Cite

This study was undertaken to determine the mechanisms mediating changes in fetal heart rate variability (FHRV) during and after exposure to asphyxia in the premature fetus. Preterm fetal sheep at 0.6 of gestation (91 +/- 1 days, term is 147 days) were exposed to either sham occlusion (n = 10) or to complete umbilical cord occlusion for either 20 (n = 7) or 30 min (n = 10). Cord occlusion led to a transient increase in FHRV with abrupt body movements that resolved after 5 min. In the 30 min group there was a marked increase in FHRV in the final 10 min of occlusion related to abnormal atrial activity. After reperfusion, FHRV in both study groups was initially suppressed and progressively increased to baseline levels over the first 4 h of recovery. In the 20 min group this improvement was associated with return of normal EEG activity and movements. In contrast, in the 30 min group the EEG was abnormal with epileptiform activity superimposed on a suppressed background, which was associated with abnormal fetal movements. As the epileptiform activity resolved, FHRV fell and became suppressed for the remainder of the study. Histological assessment after 72 h demonstrated severe brain stem injury in the 30 min group but not in the 20 min group. In conclusion, during early recovery from asphyxia, epileptiform activity and associated abnormal fetal movements related to evolving neural injury can cause a confounding transient increase in FHRV, which mimics the normal pattern of recovery. However, chronic suppression of FHRV was a strong predictor of severe brain stem injury.

show abstract

mentioning

confidence: 74%

Section: Discussionmentioning

confidence: 95%

Fetal heart rate variability and brain stem injury after asphyxia in preterm fetal sheep

George¹,

Gunn²,

Westgate³

et al. 2004

American Journal of Physiology-Regulatory, Integrative and Comp

View full text Add to dashboard Cite

show abstract

“…Decreased HRV has been correlated with stress in infants while increased HRV indicates a status of greater well‐being of the infants (11). It has also been shown that higher morbidity and mechanical ventilation cause reduction in HRV (12,13). In the present study, the total HRV increased significantly over time during the transport, suggesting that at the end of the transport the infants were less stressed and more stable.…”

Section: Discussionmentioning

confidence: 99%

Sound and vibration: effects on infants’ heart rate and heart rate variability during neonatal transport

Karlsson

Lindkvist

Karlsson³

et al. 2011

Acta Paediatrica

View full text Add to dashboard Cite

This is an accepted version of a paper published in Acta Paediatrica. This paper has been peer-reviewed but does not include the final publisher proof-corrections or journal pagination.Citation for the published paper: Karlsson, B., Lindkvist, M., Lindkvist, M., Karlsson, M., Lundström, R. et al. (2012) "Sound and vibration: effects on infants' heart rate and heart rate variability during neonatal transport." Acta Paediatrica, 101(2): 148-154 URL: http://dx.doi.org/10.1111/j. 1651-2227.2011.02472.x Access to the published version may require subscription. ABSTRACTAim: To measure the effect of sound and whole-body vibration on infants' heart rate and heart rate variability during ground and air ambulance transport.Methods: Sixteen infants were transported by air ambulance with ground ambulance transport to and from the airports. Whole-body vibration and sound levels were recorded and heart parameters were obtained by ECG signal.Results: Sound and whole-body vibration levels exceeded the recommended limits. Mean whole-body vibration and sound levels were 0.19m/s 2 and 73dBA, respectively. Higher whole-body vibration was associated with a lower heart rate (p<0.05), and higher sound level was linked to a higher heart rate (p=0.05). The heart rate variability was significantly higher at the end of the transport than at the beginning (p<0.01). Poorer physiologic status was associated with lower heart rate variability (p<0.001) and a lower heart rate (p<0.01). Infants wearing earmuffs had a lower heart rate (p<0.05). Conclusions:Sound and whole-body vibration during neonatal transport exceed recommended levels for adults and sound seem to have a more stressful effect on the infant than vibrations. Infants should wear earmuffs during neonatal transport because of the stress reducing effect.Key-words: heart rate variability, neonatal transport, sound, stress, whole-body vibration Key Notes: We have measured effects of sound and whole-body vibration on heart rate and heart rate variability on infants transported by air and ground ambulance. Sound and vibration during neonatal transport exceeded the recommended limits for adults. Neither sound nor whole-body vibration had an effect on heart rate variability, but high sound levels seems to cause a higher heart rate indicating a stressful effect on the infant while high vibration did not.

show abstract

“…HRV studies examining autonomic function in the developing fetus and premature newborn suggest a predominance of sympathetic innervation, followed by gradual development of the parasympathetic nervous system 10–12,31–35. Because an increased short-term scaling exponent represents decreased parasympathetic function,36 our results suggest that VLBW infants with impending IVH have additional alterations of parasympathetic activity.…”

Section: Discussionmentioning

confidence: 66%

Altered Heart Rhythm Dynamics in Very Low Birth Weight Infants With Impending Intraventricular Hemorrhage

et al. 2009

View full text Add to dashboard Cite

OBJECTIVE-Intraventricular hemorrhage remains an important problem among very low birth weight infants and may result in long-term neurodevelopmental disabilities. Neonatologists have been unable to accurately predict impending intraventricular hemorrhage. Because alterations in the autonomic nervous system's control of heart rhythm have been associated with intraventricular hemorrhage after its development, we sought to determine if early subtle alterations of heart rhythm could be predictive of impending intraventricular hemorrhage in very low birth weight infants.METHODS-This case-control study included 10 newborn very low birth weight infants with intraventricular hemorrhage (5 grade IV, 4 grade III, and 1 grade II) and 14 control infants without intraventricular hemorrhage. Heart rhythm data from the first day of life before the development of intraventricular hemorrhage were evaluated. Detrended fluctuation analysis, a nonlinear fractal heart rate variability method, was used to assess the fractal dynamics of the heart rhythm. Fractal scaling exponents were calculated by using this analysis.RESULTS-Twenty-four infants (mean ± SD, birth weight: 845 ± 213g: gestational age: 26.1 ± 1.9 weeks) participated in the study. The short-term scaling exponent was significantly larger in infants who later developed intraventricular hemorrhage compared with those who did not (0.60 ± 0.1 vs 0.45 ± 0.1). A value of 0.52 resulted in 70% sensitivity and positive predictive value and 79% specificity and negative predictive value. The short-term scaling exponent was the only significant predictor of intraventricular hemorrhage.CONCLUSIONS-Fractal dynamics of the heart rhythm is significantly altered in very low birth weight infants before developing intraventricular hemorrhage and may be predictive of impending intraventricular hemorrhage. 8,9 Given this important public health problem, it would be quite valuable to identify VLBW infants who are at highest risk for developing IVH, before they actually develop it, so that they may benefit from prevention and intervention strategies. Unfortunately, accurate prediction methodologies of impending IVH have not been developed.Altered autonomic function has been observed by heart rate variability (HRV) analysis in premature infants after IVH. 10-12 HRV refers to the beat-to-beat (R-R interval from the electrocardiogram) fluctuation of heart rate and reflects the balance between parasympathetic and sympathetic impulses to the heart that is under central nervous system control. Researchers have used HRV analysis as a tool to estimate autonomic neural control of the heart and for predicting impending arrhythmia 13 and long-term outcome of VLBW infants. 11,14 The objective of this study was to determine if impending IVH in VLBW infants may be predicted by altered autonomic function. We hypothesized that autonomic dysfunction precedes the development of IVH in VLBW infants. We used a nonlinear method, called detrended fluctuation analysis (DFA), 11,15 to examine the HRV characte...

show abstract

Continuous monitoring of heart rate variability in preterm infants

Cited by 25 publications

References 25 publications

Fetal heart rate variability and brain stem injury after asphyxia in preterm fetal sheep

Fetal heart rate variability and brain stem injury after asphyxia in preterm fetal sheep

Sound and vibration: effects on infants’ heart rate and heart rate variability during neonatal transport

Altered Heart Rhythm Dynamics in Very Low Birth Weight Infants With Impending Intraventricular Hemorrhage

Contact Info

Product

Resources

About