Heart rate variability in hypoxic ischemic encephalopathy: correlation with EEG grade and 2-y neurodevelopmental outcome

Goulding, Robert M.; Stevenson, Nathan J.; Murray, Deirdre M.; Livingstone, Vicki; Filan, Peter M.; Boylan, Geraldine B.

doi:10.1038/pr.2015.28

Cited by 58 publications

(70 citation statements)

References 34 publications

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“…(5-8) More recently, we and others have reported that HRV metrics may be used to stratify HIE newborns by severity (9, 10) and identify infants who are at greatest risk for death or severe MRI brain injury (11) or neurodevelopmental impairment. (12, 13) Thus, the use of HRV holds promise as a physiological biomarker to guide management of newborns with HIE.…”

Section: Introductionmentioning

confidence: 99%

Effect of Temperature on Heart Rate Variability in Neonatal ICU Patients With Hypoxic-Ischemic Encephalopathy

Massaro

Campbell

Metzler

et al. 2017

Pediatric Critical Care Medicine

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Objective To determine whether measures of heart rate variability (HRV) are related to changes in temperature during rewarming after therapeutic hypothermia (TH) for hypoxic ischemic encephalopathy (HIE). Design Prospective observational study. Setting Level 4 neonatal intensive care unit in a free-standing academic children's hospital. Patients Forty-four infants with moderate to severe HIE treated with TH. Interventions Continuous EKG data from 2 hours prior to rewarming through 2 hours after completion of rewarming (up to 10 hours) were analyzed. Measurements and Main Results Median beat-to-beat interval (RRi) and measures of HRV were quantified including RRi standard deviation (SD), low (LF) and high (HF) frequency relative spectral power, detrended fluctuation analysis short- and long- α exponents (αS, αL) and root mean square short- and long- time scales (RMSS, RMSL). The relationships between HRV measures and esophageal/axillary temperatures were evaluated. HRV measures LF, αS, RMSS, and RMSL were negatively associated, while αL was positively associated, with temperature (P<0.01). These findings signify an overall decrease in HRV as temperature increased towards normothermia. Conclusions Measures of HRV are temperature dependent in the range of TH to normothermia. Core body temperature needs to be considered when evaluating HRV metrics as potential physiological biomarkers of illness severity in HIE infants undergoing TH.

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Section: Introductionmentioning

confidence: 99%

Effect of Temperature on Heart Rate Variability in Neonatal ICU Patients With Hypoxic-Ischemic Encephalopathy

Massaro

Campbell

Metzler

et al. 2017

Pediatric Critical Care Medicine

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“…In the work of Goulding et al [17], the power of the low-frequency band (LF) predicted death or adverse neurodevelopment with an AUC of 0.79 (95% confidence interval [CI] 0.57–0.94), although the difference in LF between severity groups was no longer statistically significant when adjusted for phenobarbitone use.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies also reported the prognostic accuracy of HRV metrics beyond 24 h: AUC 0.80 (0.62–1.00) for the power of very low frequency (VLF) at 48 h [17]; 0.82 for LF at 93–96 h; 0.81 for HF at 102–105 h [16]; and 0.75 on days 4–7 of life [18] for HRC index (CI not reported). Where > 1 time point was reported, 24 h was the time point of higher accuracy but none of the studies reported data for the first 24 h of postnatal age.…”

Section: Resultsmentioning

confidence: 99%

Prognostic Accuracy of Heart Rate Variability Analysis in Neonatal Encephalopathy: A Systematic Review

Oliveira¹,

Martins²,

Liow³

et al. 2018

Neonatology

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Background: Heart rate variability analysis offers real-time quantification of autonomic disturbance after perinatal asphyxia, and may therefore aid in disease stratification and prognostication after neonatal encephalopathy (NE). Objective: To systematically review the existing literature on the accuracy of early heart rate variability (HRV) to predict brain injury and adverse neurodevelopmental outcomes after NE. Design/Methods: We systematically searched the literature published between May 1947 and May 2018. We included all prospective and retrospective studies reporting HRV metrics, within the first 7 days of life in babies with NE, and its association with adverse outcomes (defined as evidence of brain injury on magnetic resonance imaging and/or abnormal neurodevelopment at ≥1 year of age). We extracted raw data wherever possible to calculate the prognostic indices with confidence intervals. Results: We retrieved 379 citations, 5 of which met the criteria. One further study was excluded as it analysed an already-included cohort. The 4 studies provided data on 205 babies, 80 (39%) of whom had adverse outcomes. Prognostic accuracy was reported for 12 different HRV metrics and the area under the curve (AUC) varied between 0.79 and 0.94. The best performing metric reported in the included studies was the relative power of high-frequency band, with an AUC of 0.94. Conclusions: HRV metrics are a promising bedside tool for early prediction of brain injury and neurodevelopmental outcome in babies with NE. Due to the small number of studies available, their heterogeneity and methodological limitations, further research is needed to refine this tool so that it can be used in clinical practice.

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“…o HRV provides a non-invasive assessment of both the parasympathetic and sympathetic control of heart rate (HR) [241,242]. There is evidence of alternation of HR following HIE and HR is also associated with EEG grade of HIE and neurodevelopmental outcome [242].…”

Section: Limitations Of the Study And Proposed Recommendationsmentioning

confidence: 99%

“…There is evidence of alternation of HR following HIE and HR is also associated with EEG grade of HIE and neurodevelopmental outcome [242]. Therefore, different features extracted from HR and HRV could be very useful along with EEG-based features.…”

Section: Limitations Of the Study And Proposed Recommendationsmentioning

confidence: 99%

Design and optimisation of time-frequency analysis for multichannel neonatal EEG background features in term neonates with hypoxic ischaemic encephalopathy: characterisation, classification and neurodevelopmental outcome prediction

Awal¹

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Neonatal Hypoxic Ischaemic Encephalopathy (HIE) is a major cause of morbidity and mortality in newborns throughout the world with an incidence of 1-8/1000 newborns in developed countries and up to 26/1000 newborns in developing countries. It causes one million neonatal deaths globally per year. Electroencephalography (EEG) is a useful method for assessment of brain activity in newborns with HIE. EEG performs well in the early diagnosis and classification of HIE severity and in predicting neurodevelopmental outcome. A normal EEG is highly predictive of a normal outcome and various abnormal EEG features are associated with neurological abnormalities or death.A systematic review and meta-analysis of the literature was undertaken to determine which specific background features of the EEG best predict outcome (Aim 1). Automatic detection and classification

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Heart rate variability in hypoxic ischemic encephalopathy: correlation with EEG grade and 2-y neurodevelopmental outcome

Cited by 58 publications

References 34 publications

Effect of Temperature on Heart Rate Variability in Neonatal ICU Patients With Hypoxic-Ischemic Encephalopathy

Effect of Temperature on Heart Rate Variability in Neonatal ICU Patients With Hypoxic-Ischemic Encephalopathy

Prognostic Accuracy of Heart Rate Variability Analysis in Neonatal Encephalopathy: A Systematic Review

Design and optimisation of time-frequency analysis for multichannel neonatal EEG background features in term neonates with hypoxic ischaemic encephalopathy: characterisation, classification and neurodevelopmental outcome prediction

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