Correlation between diminished vagal tone and somatic dysfunction severity in very and extremely low birth weight preterm infants assessed with frequency spectrum heart rate variability and salivary cortisol

Abstract

Osteopathic manipulative treatment (OMT) is evolving in the neonatal intensive care unit (NICU) setting. Studies showed its efficacy in length of stay and hospitalization costs reduction. Moreover, it was suggested that OMT has a modulatory effect on the preterm infants' autonomic nervous system (ANS), influencing saturation and heart rate. Even if OMT is based on the palpatory examination of the somatic dysfunctions (SD), there are controversies about its identification and clinical relevance. The objective of this study was to evaluate the inter-rater reliability, clinical characteristics, and functional correlation of the SD Grade score with the heart rate variability (HRV) and the salivary cortisol (sCor) using a multivariate linear model approach. To evaluate those features, we implemented an ad hoc SD examination for preterm infants that was performed by 2 trained osteopaths. It was based on the new variability model of SD that includes an SD Grade assessment procedure. The ANS features were assessed by frequency parameters of HRV studying high frequency (HF), low frequency (LF), and HF/LF, whereas sCor was tested with a radioimmunoassay. The ANS assessment was standardized and performed before SD testing. Sixty-nine premature infants were eligible. SD Grade showed excellent concordance between the blinded raters. Using SD Grade as a grouping variable, the infants presented differences in GA, Apgar, pathological findings, length of stay, and ventilatory assistance. In our multivariate model, HF, LF, and LF/HF resulted linearly correlated with SD Grade. Instead, sCor presented a linear correlation with 5' Apgar and respiratory distress syndrome but not with SD Grade. SD Grade was in line with the natural history of the underdevelopment due to prematurity. Our models indicate that the cardiac vagal tone is linearly related with SD Grade. This finding may improve the multidisciplinary decision making inside NICU and the management of modifiable factors, like SD, for cardiac vagal tone regulation.

Model-Base Estimation of Non-Invasive Ventilation Weaning of Preterm Infants Exposed to Osteopathic Manipulative Treatment: A Propensity-Score-Matched Cohort Study

“…Both observed patterns may explain the increased ratio of NIV weaning by time in the exposed group and describe a significant oxygenation increment in preterm infants after an OMT session [ 29 ].…”

“…Osteopaths were trained to perform a specific examination protocol using the variability model of SD [ 21 , 29 ]. The exam was composed as follows: The osteopath with a manual palpatory grip between the skull and the sacrum evaluated the quality of movement and mobility on the three planes of movement.…”

“…The exam was composed as follows: The osteopath with a manual palpatory grip between the skull and the sacrum evaluated the quality of movement and mobility on the three planes of movement. The examiner assessed the movement variability within the neutral zone (NZ) of the spine with a sacro-occipital stance [ 29 ]. The examiner checked the motion reaction of the spine fascia with a light reverse rotary, opposite lateral, and traction and compression stimulus (micromotion), induced between the head and the sacral regions.…”

“…Different studies have evaluated its possible contributions in the pediatric field, looking especially at prematurity: for instance, OMT is related to reduced timing to oral feeding, shorter LOS, and improvements in cardiac frequency and oxygen saturation [ 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. Moreover, a recent study described the correlation of SD severity assessed with the Variability Model and the vagal tone in preterm infants [ 29 ]. In this perspective, the OMT added to the standard therapies may play a fundamental role in the short-term effects during the stay in the neonatal intensive care unit (NICU) and in the medium- and long-term effects for the prevention of respiratory diseases.…”

Osteopathic Manipulation as a Method of Cortisol Modification: A Systematic Review

“…OMT's potential to modify breathing and cardiac variability, especially if it has some effect on cortisol in a meaningful way, may have potential application for a multitude of conditions [15]. OMT has shown some potential in the regulation of cortisol, modifying stress responses, and being part of treatment to affect everything from vitals to the stress response [16,17].…”