Preterm Stress Behaviors, Autonomic Indices, and Maternal Perceptions of Infant Colic

Gardner, Fumiyuki C.; Adkins, Cherie S.; Hart, Sarah E.; Travagli, R. Alberto; Doheny, Kim K.

doi:10.1097/anc.0000000000000451

Cited by 20 publications

(22 citation statements)

References 67 publications

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“…Postprandial HRV data were obtained in two consecutive afternoons between noon and 5 pm for 30 to 40 minutes between days 5 and 8 of life and weekly thereafter until 35 weeks PMA using a portable data acquisition system with BioBench (National Instruments, Austin, TX) software and later analyzed by spectral analysis offline using MindWare HRV version 2.51 (Mind-Ware Technologies, LTD, Gahanna, OH). 24 Neonatal morbidity outcomes (i.e., total days on ventilation, total days on oxygen, and length of hospital stay) and short-term developmental outcomes (i.e., PMA at full oral feedings and PMA at discharge) were recorded from infants' EMR weekly from birth through discharge. SSC information was documented by nursing and inventoried retrospectively by research staff from birth through day 21 of life from infants' EMR.…”

Section: Methodsmentioning

confidence: 99%

“…Accordingly, the following frequency range was utilized while analyzing preterm neonates' cardiac vagal tone: high-frequency (HF)/respiratory sinus arrhythmia band ¼ 0.3 to 1.3 Hz, to correlate with the faster resting breathing rates of 20 to 80 breaths/min in the preterm neonates in our sample population. 24,27 Using fast Fourier transform, spectral analysis was conducted on a mean of 13 120-second segments of R-R wave data collected from two consecutive afternoons during 30 to 40 minutes HRV measurement sessions. Each segmental analysis was manually screened to be free from movement artifact and ectopic beats.…”

Section: Methodsmentioning

confidence: 99%

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Increased Frequency of Skin-to-Skin Contact Is Associated with Enhanced Vagal Tone and Improved Health Outcomes in Preterm Neonates

et al. 2018

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Increased Frequency of Skin-to-Skin Contact Is Associated with Enhanced Vagal Tone and Improved Health Outcomes in Preterm Neonates

et al. 2018

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“…Increased HRV, and specifically HF-HRV power, indicate preterm infants' ANS stability and ability to modulate stress, where decreased HRV can be correlated with pathological conditions [51]. According to the neurovisceral integration model, HRV analysis provides a unique insight to brain activity and the heart-brain connection, as it indexes the cardiac vagal tone, and may reflect the functionality of neural networks that are implicated in regulation of physiological, affective, and cognitive processes [52].…”

Section: Discussionmentioning

confidence: 99%

Effects of Live Music Therapy on Autonomic Stability in Preterm Infants: A Cluster-Randomized Controlled Trial

et al. 2021

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Unbuffered stress levels may negatively influence preterm-infants’ autonomic nervous system (ANS) maturation, thus affecting neurobehavior and psycho-emotional development. Music therapy (MT) is an evidence-based treatment modality in neonatal care. When coupled with skin-to-skin care (SSC), it may reduce stress responses in both preterm infants and their parents and enhance family-centered care. Accordingly, we aimed to compare the effects of combined MT and SSC and SSC alone on ANS stabilization in preterm infants. In a single-center, cluster-randomized trial design, ten two-month time-clusters were randomized to either combined MT and SSC or SSC alone. Families of preterm infants were offered two sessions of the allocated condition in the NICU, and a three-month follow up session at home. The primary outcome variable was stabilization of the ANS, defined by change in the high frequency (HF) power of heart rate variability (HRV) during the second session. Secondary outcomes included other HRV measures, parent–infant attachment, and parental anxiety at each session. Sixty-eight families were included. MT combined with SSC improved infants’ ANS stability, as indicated by a greater increase in HF power during MT compared to SSC alone (mean difference 5.19 m2/Hz, SE = 1.27, p < 0.001) (95% confidence interval 0.87 to 2.05). Most secondary outcomes were not significantly different between the study groups. MT contributes to preterm-infants’ autonomic stability, thus laying an important foundation for neuro-behavioral and psycho-emotional development. Studies evaluating longer-term effects of MT on preterm infants’ development are warranted.

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“…Real-time HRV helped identify stress-related behaviors, which are difficult to visually recognize: for example, LF increased during stress behaviors, whereas HF increased with self-consoling behaviors (Gardner et al, 2018). Moreover, real-time HRV monitoring-as revealed by changes in short-and long-term metrics, such as RMSSD, LF/HF, SampEn, and DFA α1 (but also SDNN, LF, HF, SD1, SD2, ApEn, and DFA α2) or in the newborn infant parasympathetic evaluation (NIPE)-correlated with nociceptive events, such as heel stick (Weissman et al, 2012;Butruille et al, 2015).…”

Section: The Clinical Usefulness Of Real-time Hrv To Monitor Newbornsmentioning

confidence: 99%

“…Several studies showed that HRV correlates with the newborn's stress and stress-related behaviors (Gardner et al, 2018;Hashiguchi et al, 2020), and that it could predict the baby's overall wellbeing and future neurological development. HRV could also accurately identify short-and long-term complications, such as the risk of sepsis (Javorka et al, 2017;Oliveira et al, 2019b;Kumar et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Heart Rate Variability in the Perinatal Period: A Critical and Conceptual Review

Chiera¹,

Cerritelli²,

Casini³

et al. 2020

Front. Neurosci.

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Neonatal intensive care units (NICUs) greatly expand the use of technology. There is a need to accurately diagnose discomfort, pain, and complications, such as sepsis, mainly before they occur. While specific treatments are possible, they are often timeconsuming, invasive, or painful, with detrimental effects for the development of the infant. In the last 40 years, heart rate variability (HRV) has emerged as a noninvasive measurement to monitor newborns and infants, but it still is underused. Hence, the present paper aims to review the utility of HRV in neonatology and the instruments available to assess it, showing how HRV could be an innovative tool in the years to come. When continuously monitored, HRV could help assess the baby's overall wellbeing and neurological development to detect stress-/painrelated behaviors or pathological conditions, such as respiratory distress syndrome and hyperbilirubinemia, to address when to perform procedures to reduce the baby's stress/pain and interventions, such as therapeutic hypothermia, and to avoid severe complications, such as sepsis and necrotizing enterocolitis, thus reducing mortality. Based on literature and previous experiences, the first step to efficiently introduce HRV in the NICUs could consist in a monitoring system that uses photoplethysmography, which is low-cost and non-invasive, and displays one or a few metrics with good clinical utility. However, to fully harness HRV clinical potential and to greatly improve neonatal care, the monitoring systems will have to rely on modern bioinformatics (machine learning and artificial intelligence algorithms), which could easily integrate infant's HRV metrics, vital signs, and especially past history, thus elaborating models capable to efficiently monitor and predict the infant's clinical conditions. For this reason, hospitals and institutions will have to establish tight collaborations between the obstetric, neonatal, and pediatric departments: this way, healthcare would truly improve in every stage of the perinatal period (from conception to the first years of life), since information about patients' health would flow freely among different professionals, and high-quality research could be performed integrating the data recorded in those departments.

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Preterm Stress Behaviors, Autonomic Indices, and Maternal Perceptions of Infant Colic

Abstract: Further study in a larger sample is needed to determine whether behavioral stress measures and HF-HRV may be useful to determine colic risk.

Cited by 20 publications

References 67 publications

Increased Frequency of Skin-to-Skin Contact Is Associated with Enhanced Vagal Tone and Improved Health Outcomes in Preterm Neonates

Increased Frequency of Skin-to-Skin Contact Is Associated with Enhanced Vagal Tone and Improved Health Outcomes in Preterm Neonates

Effects of Live Music Therapy on Autonomic Stability in Preterm Infants: A Cluster-Randomized Controlled Trial

Heart Rate Variability in the Perinatal Period: A Critical and Conceptual Review

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