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Nosetti L, Zaffanello M, Lombardi C, Gerosa A, Piacentini G, Abramo M, Agosti M. Early Screening for Long QT Syndrome and Cardiac Anomalies in Infants: A Comprehensive Study. Clin Pract 2024; 14:1038-1053. [PMID: 38921260 PMCID: PMC11203353 DOI: 10.3390/clinpract14030082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/26/2024] [Accepted: 05/30/2024] [Indexed: 06/27/2024] Open
Abstract
(1) Background: Sudden Infant Death Syndrome (SIDS) represents sudden and unexplained deaths during the sleep of infants under one year of age, despite thorough investigation. Screening for a prolonged QTc interval, a marker for Long QT Syndrome (LQTS), should be conducted on all newborns to reduce the incidence of SIDS. Neonatal electrocardiograms (ECGs) could identify congenital heart defects (CHDs) early, especially those not detected at birth. Infants with prolonged QTc intervals typically undergo genetic analysis for Long QT Syndrome. (2) Methods: The study involved infants aged 20-40 days, born with no apparent clinical signs of heart disease, with initial ECG screening. Infants with prenatal diagnoses or signs/symptoms of CHDs identified immediately after birth, as well as infants who had previously had an ECG or echocardiogram for other medical reasons, were excluded from the study. We used statistical software (SPSS version 22.0) to analyze the data. (3) Results: Of the 42,200 infants involved, 2245 were enrolled, with 39.9% being males. Following this initial screening, 164 children (37.8% males) with prolonged QTc intervals underwent further evaluation. Out of these 164 children, 27 children were confirmed to have LQTS. However, only 18 children were finally investigated for genetic mutations, and mutations were identified in 11 tests. The most common mutations were LQT1 (54.5%), LQT2 (36.4%), and LQT3 (1 patient). Treatment options included propranolol (39.8%), nadolol (22.2%), inderal (11.1%), metoprolol (11.1%), and no treatment (16.7%). The most common abnormalities were focal right bundle branch block (54.5%), left axis deviation (9.2%), and nonspecific ventricular repolarization abnormalities (7.1%). Multiple anomalies were found in 0.47% of children with focal right bundle branch block. Structural abnormalities were associated with specific features in 267 patients (11.9%), primarily isolated patent foramen ovale (PFO) at 61.4%. (4) Conclusions: This screening approach has demonstrated effectiveness in the early identification of LQTS and other cardiac rhythm anomalies, with additional identification of mutations and/or prolonged QTc intervals in family members. Identifying other ECG abnormalities and congenital heart malformations further enhances the benefits of the screening.
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Affiliation(s)
- Luana Nosetti
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.)
| | - Marco Zaffanello
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Carolina Lombardi
- Sleep Disorders Center, Department of Cardiology Istituto Auxologico, IRCCS, 20149 Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Alessandra Gerosa
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.)
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Michele Abramo
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.)
| | - Massimo Agosti
- Woman and Child Department, Varese Hospital, Insubria University, Via Ravasi 2, 21100 Varese, Italy;
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Krzeczkowski JE, Hall M, Saint-Amour D, Oulhote Y, McGuckin T, Goodman CV, Green R, Muckle G, Lanphear B, Till C. Prenatal fluoride exposure, offspring visual acuity and autonomic nervous system function in 6-month-old infants. ENVIRONMENT INTERNATIONAL 2024; 183:108336. [PMID: 38064923 PMCID: PMC10981044 DOI: 10.1016/j.envint.2023.108336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/10/2023] [Accepted: 11/17/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Prenatal fluoride exposure can have adverse effects on children's development; however, associations with visual and cardiac autonomic nervous system functioning are unknown. We examined associations between prenatal fluoride exposure and visual acuity and heart rate variability (HRV) in 6-month-old infants. METHODS We used data from Canadian mother-infant pairs participating in the Maternal-Infant Research on Environmental Chemicals (MIREC) cohort. We estimated prenatal fluoride exposure using: i) fluoride concentration in drinking water (mg/L), ii) maternal urinary fluoride adjusted for specific gravity (MUFSG; mg/L) and averaged across pregnancy, and iii) maternal fluoride intake (µg/kg/day) from consumption of water, tea, and coffee, adjusted for maternal body weight (kg). We used multivariable linear regression to examine associations between each measure of fluoride exposure and Teller Acuity Card visual acuity scores (n = 435) and assessed HRV (n = 400) using two measures: root mean square of successive differences (RMSSD) and the standard deviation of N-N intervals (SDNN) measured at 6-months of age. RESULTS Median (IQR) values for water fluoride, MUFSG, and daily fluoride intake were 0.20 (IQR: 0.13-0.56) mg/L; 0.44 (0.28-0.70) mg/L and 4.82 (2.58-10.83) µg/kg/day, respectively. After adjustment for confounding variables, water fluoride concentration was associated with poorer infant visual acuity (B = -1.51; 95 % CI: -2.14,-0.88) and HRV as indicated by lower RMSSD (B = -1.60; 95 % CI: -2.74,-0.46) but not SDNN. Maternal fluoride intake was also associated with poorer visual acuity (B = -0.82; 95 % CI: -1.35,-0.29) and lower RMSSD (B = -1.22; 95 % CI: -2.15,-0.30). No significant associations were observed between MUFSG and visual acuity or HRV. CONCLUSION Fluoride in drinking water was associated with reduced visual acuity and alterations in cardiac autonomic function in infancy, adding to the growing body of evidence suggesting fluoride's developmental neurotoxicity.
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Affiliation(s)
- John E Krzeczkowski
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada.
| | - Meaghan Hall
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Dave Saint-Amour
- Faculté de médecine - Département d'ophtalmologie, Université de Montréal, Montréal, Québec, Canada
| | - Youssef Oulhote
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sina, New York, NY, USA
| | - Taylor McGuckin
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Carly V Goodman
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Rivka Green
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Gina Muckle
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada; École de Psychologie, Université Laval, Québec, Québec, Canada
| | - Bruce Lanphear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Christine Till
- Department of Psychology, York University, Toronto, Ontario, Canada
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3
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Maxwell JR, DiDomenico J, Roberts MH, Marquez LE, Rai R, Weinberg J, Jacobson SW, Stephen J, Bakhireva LN. Impact of low-level prenatal alcohol exposure and maternal stress on autonomic regulation. Pediatr Res 2024; 95:350-358. [PMID: 37674025 PMCID: PMC11089775 DOI: 10.1038/s41390-023-02799-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/07/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) impacts the neurodevelopment of the fetus, including the infant's ability to self-regulate. Heart rate variability (HRV), that is, the beat-to-beat variability in heart rate, is a non-invasive measurement that can indicate autonomic nervous system (ANS) function/dysfunction. METHODS The study consisted of a subset of our ENRICH-2 cohort: 80 participants (32 PAE and 48 Controls) who had completed three visits during pregnancy. The participants completed a comprehensive assessment of PAE and other substances throughout pregnancy and assessments for stress, anxiety, and depression in the third trimester. At 24 h of age, infant HRV was assessed in the hospital during the clinically indicated heel lance; 3- to 5-min HRV epochs were obtained during baseline, heel lancing, and recovery episodes. RESULTS Parameters of HRV differed in infants with PAE compared to Controls during the recovery phase of the heel lance (respiratory sinus arrhythmia (RSA) and high-frequency (HF), p < 0.05). Increased maternal stress was also strongly associated with abnormalities in RSA, HF, and low-frequency / high-frequency (LF/HF, p's < 0.05). CONCLUSIONS Alterations in ANS regulation associated with PAE and maternal stress may reflect abnormal development of the hypothalamic-pituitary-adrenal axis and have long term implications for infant responsiveness and self-regulation. IMPACT Previous studies have focused on effects of moderate to heavy prenatal alcohol exposure (PAE) on autonomic dysregulation, but little is known about the effects of lower levels of PAE on infant self-regulation and heart rate variability (HRV). Prenatal stress is another risk factor for autonomic dysregulation. Mild PAE impacts infant self-regulation, which can be assessed using HRV. However, the effect of prenatal stress is stronger than that of mild PAE or other mental health variables on autonomic dysregulation.
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Affiliation(s)
- Jessie R Maxwell
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, Mexico.
- Department of Neurosciences, University of New Mexico, Albuquerque, NM, Mexico.
| | - Jared DiDomenico
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Melissa H Roberts
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Lidia Enriquez Marquez
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Rajani Rai
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Joanne Weinberg
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Sandra W Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Julia Stephen
- The Mind Research Network, a Division of Lovelace Biomedical Research Institute, University of New Mexico, Albuquerque, NM, Mexico
| | - Ludmila N Bakhireva
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
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Andreu-Fernández V, Serra-Delgado M, Almeida-Toledano L, García-Meseguer À, Vieiros M, Ramos-Triguero A, Muñoz-Lozano C, Navarro-Tapia E, Martínez L, García-Algar Ó, Gómez-Roig MD. Effect of Postnatal Epigallocatechin-Gallate Treatment on Cardiac Function in Mice Prenatally Exposed to Alcohol. Antioxidants (Basel) 2023; 12:antiox12051067. [PMID: 37237934 DOI: 10.3390/antiox12051067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/24/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023] Open
Abstract
Prenatal alcohol exposure affects the cardiovascular health of the offspring. Epigallocatechin-3-gallate (EGCG) may be a protective agent against it, but no data are available regarding its impact on cardiac dysfunction. We investigated the presence of cardiac alterations in mice prenatally exposed to alcohol and the effect of postnatal EGCG treatment on cardiac function and related biochemical pathways. C57BL/6J pregnant mice received 1.5 g/kg/day (Mediterranean pattern), 4.5 g/kg/day (binge pattern) of ethanol, or maltodextrin until Day 19 of pregnancy. Post-delivery, treatment groups received EGCG-supplemented water. At post-natal Day 60, functional echocardiographies were performed. Heart biomarkers of apoptosis, oxidative stress, and cardiac damage were analyzed by Western blot. BNP and Hif1α increased and Nrf2 decreased in mice prenatally exposed to the Mediterranean alcohol pattern. Bcl-2 was downregulated in the binge PAE drinking pattern. Troponin I, glutathione peroxidase, and Bax increased in both ethanol exposure patterns. Prenatal alcohol exposure led to cardiac dysfunction in exposed mice, evidenced by a reduced ejection fraction, left ventricle posterior wall thickness at diastole, and Tei index. EGCG postnatal therapy restored the physiological levels of these biomarkers and improved cardiac dysfunction. These findings suggest that postnatal EGCG treatment attenuates the cardiac damage caused by prenatal alcohol exposure in the offspring.
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Affiliation(s)
- Vicente Andreu-Fernández
- Grup de Recerca Infancia i Entorn (GRIE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Biosanitary Research Institute, Valencian International University (VIU), 46002 Valencia, Spain
| | - Mariona Serra-Delgado
- Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de Barcelona, 08950 Barcelona, Spain
| | - Laura Almeida-Toledano
- Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de Barcelona, 08950 Barcelona, Spain
| | - Àgueda García-Meseguer
- Grup de Recerca Infancia i Entorn (GRIE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Department of Neonatology, Hospital Clínic-Maternitat, ICGON, IDIBAPS, BCNatal, 08028 Barcelona, Spain
| | - Melina Vieiros
- Grup de Recerca Infancia i Entorn (GRIE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Department of Neonatology, Hospital Clínic-Maternitat, ICGON, IDIBAPS, BCNatal, 08028 Barcelona, Spain
| | - Anna Ramos-Triguero
- Grup de Recerca Infancia i Entorn (GRIE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Department of Neonatology, Hospital Clínic-Maternitat, ICGON, IDIBAPS, BCNatal, 08028 Barcelona, Spain
| | - Concha Muñoz-Lozano
- Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de Barcelona, 08950 Barcelona, Spain
| | - Elisabet Navarro-Tapia
- Biosanitary Research Institute, Valencian International University (VIU), 46002 Valencia, Spain
| | - Leopoldo Martínez
- Department of Pediatric Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Óscar García-Algar
- Grup de Recerca Infancia i Entorn (GRIE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Department of Neonatology, Hospital Clínic-Maternitat, ICGON, IDIBAPS, BCNatal, 08028 Barcelona, Spain
| | - María D Gómez-Roig
- Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de Barcelona, 08950 Barcelona, Spain
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McDonnell P, Fornell P, Ponce S, Dyer L. Baseline heart rate in infants with prenatal alcohol exposure: A systematic review and independent analysis. Birth Defects Res 2023; 115:474-487. [PMID: 36515170 DOI: 10.1002/bdr2.2135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/22/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Infants with fetal alcohol syndrome exhibit a range of developmental anomalies, many related to the heart (e.g., decreased heart rate variability). However, the baseline heart rate in this population remains unclear. We hypothesized that the age at which heart rate was measured or the age during exposure to alcohol affects the baseline heart rate. METHODS First, we conducted a systemic review to determine the published heart rate of infants with prenatal alcohol exposure (PAE). Exclusion criteria included potentially confounding factors, including the commonly associated phenotypes of small for gestational age and premature birth. Risk of bias was evaluated based on case study limitations, and data were compared with established heart rate norms. Then, we evaluated the precise age at heart rate measurement using existing datasets from the Collaborative Initiative on Fetal Alcohol Spectrum Disorders and the Maternal Lifestyle Study. RESULTS Based on the weighted means of six studies, the baseline heart rate was 4.6 bpm higher in infants with PAE (n = 253) than in control infants (n = 152). Using the individual patient data, baseline heart rates were similar between age-matched infants with PAE and control infants who were born full-term and showed no signs of growth restriction (ANOVA, p > .05; n = 49-124 infants per age and exposure). CONCLUSIONS A systematic literature review suggested that heart rate is elevated in infants with PAE, but these findings are limited by the number of studies and how few studies included control infants. The analysis of individual patient data indicates that infants with PAE have normal baseline heart rates. This knowledge may help clinicians detect changes in cardiac function in infants with PAE. (Registered via PROSPERO, #CRD42020191212.).
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Affiliation(s)
- Peyton McDonnell
- Department of Biology, University of Portland, Portland, Oregon, USA
| | - Pia Fornell
- Department of Biology, University of Portland, Portland, Oregon, USA
| | - Sarah Ponce
- Department of Biology, University of Portland, Portland, Oregon, USA
| | - Laura Dyer
- Department of Biology, University of Portland, Portland, Oregon, USA
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Sania A, Myers MM, Pini N, Lucchini M, Nugent JD, Shuffrey LC, Rao S, Barbosa J, Angal J, Elliott AJ, Odendaal HJ, Fifer WP. Prenatal smoking and drinking are associated with altered newborn autonomic functions. Pediatr Res 2023; 93:242-252. [PMID: 35440768 PMCID: PMC9579213 DOI: 10.1038/s41390-022-02060-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Prenatal smoking and drinking are associated with sudden infant death syndrome and neurodevelopmental disorders. Infants with these outcomes also have altered autonomic nervous system (ANS) regulation. We examined the effects of prenatal smoking and drinking on newborn ANS function. METHODS Pregnant women were enrolled in Northern Plains, USA (NP) and Cape Town (CT), South Africa. Daily drinking and weekly smoking data were collected prenatally. Physiological measures were obtained during sleep 12-96 h post-delivery. RESULTS In all, 2913 infants from NP and 4072 from CT were included. In active sleep, newborns of mothers who smoked throughout pregnancy, compared to non-smokers, had higher breathing rates (2.2 breaths/min; 95% CI: 0.95, 3.49). Quit-early smoking was associated with reductions in beat-to-beat heart rate variability (HRV) in active (-0.08 s) and quiet sleep (-0.11 s) in CT. In girls, moderate-high continuous smoking was associated with increased systolic (3.0 mmHg, CI: 0.70, 5.24) and diastolic blood pressure (2.9 mmHg, CI: 0.72, 5.02). In quiet sleep, low-continuous drinking was associated with slower heart rate (-4.5 beat/min). In boys, low-continuous drinking was associated with a reduced ratio of low-to-high frequency HRV (-0.11, CI: -0.21, -0.02). CONCLUSIONS These findings highlight potential ANS pathways through which prenatal drinking and smoking may contribute to neurodevelopment outcomes. IMPACT In this prospective cohort study of 6985 mother-infant dyads prenatal drinking and smoking were associated with multiple ANS parameters. Smoking was associated with increased neonatal breathing rates among all infants, and heart rate variability (HRV) and blood pressure (BP) among girls. Drinking was associated with reductions in HR and BP among all newborns, and reductions in the ratio of low to-high frequency HRV among boys. These findings suggest that prenatal smoking and drinking alter newborn ANS which may presage future neurodevelopmental disorders.
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Affiliation(s)
- Ayesha Sania
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, 10032, USA. .,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, 10032, USA.
| | - Michael M. Myers
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032
| | - Nicolò Pini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032
| | - Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032
| | - J David Nugent
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032
| | - Lauren C. Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032
| | - Shreya Rao
- Department of Statistics, Columbia University, New York, NY 10032
| | - Jennifer Barbosa
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032
| | - Jyoti Angal
- Avera Research Institute, Sioux Falls, SD 57108,Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD 57105
| | - Amy J. Elliott
- Avera Research Institute, Sioux Falls, SD 57108,Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD 57105
| | - Hein J. Odendaal
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, Western Cape, South Africa 7530
| | - William P. Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032,Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032
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7
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Moon RY, Carlin RF, Hand I. Evidence Base for 2022 Updated Recommendations for a Safe Infant Sleeping Environment to Reduce the Risk of Sleep-Related Infant Deaths. Pediatrics 2022; 150:188305. [PMID: 35921639 DOI: 10.1542/peds.2022-057991] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Every year in the United States, approximately 3500 infants die of sleep-related infant deaths, including sudden infant death syndrome (SIDS) (International Statistical Classification of Diseases and Related Health Problems 10th Revision [ICD-10] R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After a substantial decline in sleep-related deaths in the 1990s, the overall death rate attributable to sleep-related infant deaths have remained stagnant since 2000, and disparities persist. The triple risk model proposes that SIDS occurs when an infant with intrinsic vulnerability (often manifested by impaired arousal, cardiorespiratory, and/or autonomic responses) undergoes an exogenous trigger event (eg, exposure to an unsafe sleeping environment) during a critical developmental period. The American Academy of Pediatrics recommends a safe sleep environment to reduce the risk of all sleep-related deaths. This includes supine positioning; use of a firm, noninclined sleep surface; room sharing without bed sharing; and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include human milk feeding; avoidance of exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs; routine immunization; and use of a pacifier. New recommendations are presented regarding noninclined sleep surfaces, short-term emergency sleep locations, use of cardboard boxes as a sleep location, bed sharing, substance use, home cardiorespiratory monitors, and tummy time. In addition, additional information to assist parents, physicians, and nonphysician clinicians in assessing the risk of specific bed-sharing situations is included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, which is included in this issue.
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Affiliation(s)
- Rachel Y Moon
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Rebecca F Carlin
- Division of Pediatric Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York City, New York
| | - Ivan Hand
- Department of Pediatrics, SUNY-Downstate College of Medicine, NYC Health + Hospitals, Kings County, Brooklyn, New York
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8
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Sodini C, Paglialonga L, Antoniol G, Perrone S, Principi N, Esposito S. Home Cardiorespiratory Monitoring in Infants at Risk for Sudden Infant Death Syndrome (SIDS), Apparent Life-Threatening Event (ALTE) or Brief Resolved Unexplained Event (BRUE). LIFE (BASEL, SWITZERLAND) 2022; 12:life12060883. [PMID: 35743914 PMCID: PMC9227273 DOI: 10.3390/life12060883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022]
Abstract
Sudden infant death syndrome (SIDS) is defined as the sudden death of an infant younger than one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history. About 90% of SIDS occur before six months of age, the peak incidence is between two and four months, and the median age for death is elven weeks. The clinical, social, and economic relevance of SIDS, together with the evidence that prevention of this syndrome was possible, has significantly stimulated research into risk factors for the development of SIDS in the hope of being able to introduce new effective preventive measures. This narrative review discusses the potential relationships between apparent life-threatening events (ALTE) or brief resolved unexplained events (BRUE) and SIDS development, and when a home cardiorespiratory monitor is useful for prevention of these conditions. A literature analysis showed that home cardiorespiratory monitoring has been considered a potential method to identify not only ALTE and BRUE but SIDS also. ALTE and BRUE are generally due to underlying conditions that are not detectable in SIDS infants. A true relationship between these conditions has never been demonstrated. Use of home cardiorespiratory monitor is not recommended for SIDS, whereas it could be suggested for children with previous ALTE or severe BRUE or who are at risk of the development of these conditions. However, use of home cardiorespiratory monitors assumes that family members know the advantages and limitations of these devices after adequate education and instruction in their use.
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Affiliation(s)
- Chiara Sodini
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (C.S.); (L.P.); (G.A.)
| | - Letizia Paglialonga
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (C.S.); (L.P.); (G.A.)
| | - Giulia Antoniol
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (C.S.); (L.P.); (G.A.)
| | - Serafina Perrone
- Neonatology Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
| | | | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (C.S.); (L.P.); (G.A.)
- Correspondence: ; Tel.: +39-05-2190-3524
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9
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Butyrylcholinesterase is a potential biomarker for Sudden Infant Death Syndrome. EBioMedicine 2022; 80:104041. [PMID: 35533499 PMCID: PMC9092508 DOI: 10.1016/j.ebiom.2022.104041] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Autonomic dysfunction has been implicated in the pathophysiology of the Sudden Infant Death Syndrome (SIDS). Butyrylcholinesterase (BChE) is an enzyme of the cholinergic system, a major branch of the autonomic system, and may provide a measure of autonomic (dys)function. This study was undertaken to evaluate BChE activity in infants and young children who had died from Sudden Infant Death or Sudden Unexpected Death. Methods In this case-control study we measured BChE activity and total protein in the eluate of 5μL spots punched from the dried blood spots taken at birth as part of the newborn screening program. Results for each of 67 sudden unexpected deaths classified by the coroner (aged 1 week-104 weeks) = Cases, were compared to 10 date of birth - and gender-matched surviving controls (Controls), with five cases reclassified to meet criteria for SIDS, including the criterion of age 3 weeks to 1 year. Findings Conditional logistic regression showed that in groups where cases were reported as “SIDS death” there was strong evidence that lower BChE specific activity (BChEsa) was associated with death (OR=0·73 per U/mg, 95% CI 0·60-0·89, P=0·0014), whereas in groups with a “Non-SIDS death” as the case there was no evidence of a linear association between BChEsa and death (OR=1·001 per U/mg, 95% CI 0·89-1·13, P=0·99). Interpretation BChEsa, measured in dried blood spots taken 2-3 days after birth, was lower in babies who subsequently died of SIDS compared to surviving controls and other Non-SIDS deaths. We conclude that a previously unidentified cholinergic deficit, identifiable by abnormal -BChEsa, is present at birth in SIDS babies and represents a measurable, specific vulnerability prior to their death. Funding All funding provided by a crowd funding campaign https://www.mycause.com.au/p/184401/damiens-legacy
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10
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Latremouille S, Lam J, Shalish W, Sant'Anna G. Neonatal heart rate variability: a contemporary scoping review of analysis methods and clinical applications. BMJ Open 2021; 11:e055209. [PMID: 34933863 PMCID: PMC8710426 DOI: 10.1136/bmjopen-2021-055209] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Neonatal heart rate variability (HRV) is widely used as a research tool. However, HRV calculation methods are highly variable making it difficult for comparisons between studies. OBJECTIVES To describe the different types of investigations where neonatal HRV was used, study characteristics, and types of analyses performed. ELIGIBILITY CRITERIA Human neonates ≤1 month of corrected age. SOURCES OF EVIDENCE A protocol and search strategy of the literature was developed in collaboration with the McGill University Health Center's librarians and articles were obtained from searches in the Biosis, Cochrane, Embase, Medline and Web of Science databases published between 1 January 2000 and 1 July 2020. CHARTING METHODS A single reviewer screened for eligibility and data were extracted from the included articles. Information collected included the study characteristics and population, type of HRV analysis used (time domain, frequency domain, non-linear, heart rate characteristics (HRC) parameters) and clinical applications (physiological and pathological conditions, responses to various stimuli and outcome prediction). RESULTS Of the 286 articles included, 171 (60%) were small single centre studies (sample size <50) performed on term infants (n=136). There were 138 different types of investigations reported: physiological investigations (n=162), responses to various stimuli (n=136), pathological conditions (n=109) and outcome predictor (n=30). Frequency domain analyses were used in 210 articles (73%), followed by time domain (n=139), non-linear methods (n=74) or HRC analyses (n=25). Additionally, over 60 different measures of HRV were reported; in the frequency domain analyses alone there were 29 different ranges used for the low frequency band and 46 for the high frequency band. CONCLUSIONS Neonatal HRV has been used in diverse types of investigations with significant lack of consistency in analysis methods applied. Specific guidelines for HRV analyses in neonates are needed to allow for comparisons between studies.
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Affiliation(s)
- Samantha Latremouille
- Division of Experimental Medicine, McGill University Health Centre, Montreal, Québec, Canada
| | - Justin Lam
- Medicine, Griffith University, Nathan, Queensland, Australia
| | - Wissam Shalish
- Division of Neonatology, McGill University Health Center, Montreal, Québec, Canada
| | - Guilherme Sant'Anna
- Division of Neonatology, McGill University Health Center, Montreal, Québec, Canada
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11
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Sudden Infant Death Syndrome: Beyond Risk Factors. Life (Basel) 2021; 11:life11030184. [PMID: 33652660 PMCID: PMC7996806 DOI: 10.3390/life11030184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 12/12/2022] Open
Abstract
Sudden infant death syndrome (SIDS) is defined as "the sudden death of an infant under 1 year of age which remains unexplained after thorough investigation including a complete autopsy, death scene investigation, and detailed clinical and pathological review". A significant decrease of SIDS deaths occurred in the last decades in most countries after the beginning of national campaigns, mainly as a consequence of the implementation of risk reduction action mostly concentrating on the improvement of sleep conditions. Nevertheless, infant mortality from SIDS still remains unacceptably high. There is an urgent need to get insight into previously unexplored aspects of the brain system with a special focus on high-risk groups. SIDS pathogenesis is associated with a multifactorial condition that comprehends genetic, environmental and sociocultural factors. Effective prevention of SIDS requires multiple interventions from different fields. Developing brain susceptibility, intrinsic vulnerability and early identification of infants with high risk of SIDS represents a challenge. Progress in SIDS research appears to be fundamental to the ultimate aim of eradicating SIDS deaths. A complex model that combines different risk factor data from biomarkers and omic analysis may represent a tool to identify a SIDS risk profile in newborn settings. If high risk is detected, the infant may be referred for further investigations and follow ups. This review aims to illustrate the most recent discoveries from different fields, analyzing the neuroanatomical, genetic, metabolic, proteomic, environmental and sociocultural aspects related to SIDS.
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12
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Torchin H, Le Lous M, Houdouin V. [In Utero Exposure to Maternal Smoking: Impact on the Child from Birth to Adulthood - CNGOF-SFT Expert Report and Guidelines for Smoking Management during Pregnancy]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:567-577. [PMID: 32247092 DOI: 10.1016/j.gofs.2020.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Smoking during pregnancy leads to fetal passive smoking. It is associated with several obstetrical complications and is a major modifiable factor of maternal and fetal morbidity. Long-term consequences also exist but are less well known to health professionals and in the general population. METHODS Consultation of the Medline® database. RESULTS Maternal smoking during pregnancy is associated in the offspring with sudden infant death syndrome (NP2), impaired lung function (NP2), lower respiratory infections and asthma (NP2), overweight and obesity (NP2), cancers (NP3), risk of tobacco use, nicotine dependence and early smoking initiation (NP2). Unadjusted analyses show associations between in utero tobacco exposure and cognitive deficits (NP3), impaired school performance (NP3) and behavioral disorders in children (NP2), which are in a large part explained by environmental factors. There is a cross-generational effect of smoking during pregnancy. For example, an increased risk of asthma is observed in the grandchildren of smoking women (NP4). The respective roles of ante- and post-natal smoking remain difficult to assess. CONCLUSION These results highlight the importance of prevention measures against tobacco use in the general population, as well as screening measures and support for smoking cessation before or at the beginning of the pregnancy.
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Affiliation(s)
- H Torchin
- Service de médecine et réanimation néonatales de Port-Royal, groupe hospitalier Cochin-Hôtel Dieu, Assistance publique-Hôpitaux de Paris, 123, boulevard de Port-Royal, 75014 Paris, France; Centre de recherche épidémiologie et statistique Sorbonne Paris Cité, Inserm, INRA, université de Paris, 75004 Paris, France.
| | - M Le Lous
- Département de gynécologie-obstétrique et médecine de la reproduction, centre hospitalier universitaire de Rennes, 35000 Rennes, France; LTSI-Inserm, université de Rennes 1, UMR 1099, 35000 Rennes, France
| | - V Houdouin
- Service de pneumologie, allergologie et CRCM pédiatrique, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Inserm UMR S 976, immunologie humaine, physiologie et immunothérapie, faculté Paris Diderot, 75018 Paris, France
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13
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Krzeczkowski JE, Boylan K, Arbuckle TE, Muckle G, Poliakova N, Séguin JR, Favotto LA, Savoy C, Amani B, Mortaji N, Van Lieshout RJ. Maternal Pregnancy Diet Quality Is Directly Associated with Autonomic Nervous System Function in 6-Month-Old Offspring. J Nutr 2020; 150:267-275. [PMID: 31573610 DOI: 10.1093/jn/nxz228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/15/2019] [Accepted: 08/28/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Many pregnant women are consuming diets of poor overall quality. Although many studies have linked poor prenatal diet quality to an increased risk of specific diseases in offspring, it is not known if exposure to poor prenatal diet affects core neurophysiological regulatory systems in offspring known to lie upstream of multiple diseases. OBJECTIVE We aimed to examine the association between prenatal diet quality and autonomic nervous system (ANS) function in infants at 6 mo of age. METHODS Data from 400 women (aged >18 y, with uncomplicated pregnancies) and their infants participating in the Maternal-Infant Research on Environmental Chemicals-Infant Development cohort were used to investigate links between prenatal diet quality and infant ANS function at 6 mo of age. Prenatal diet quality was assessed using the Healthy Eating Index (2010), calculated from a validated FFQ completed by women during the first trimester. Infant ANS function was measured using 2 assessments of heart rate variability (HRV) including root mean square of successive differences (RMSSD) and SD of N-N intervals (SDNN). Associations were analyzed before and after adjustment for socioeconomic status, maternal depression symptoms, maternal cardiometabolic dysfunction, breastfeeding, and prenatal smoking. RESULTS Poorer prenatal diet quality was associated with lower infant HRV assessed using RMSSD (B: 0.07; 95% CI: 0.01, 0.13; R2 = 0.013) and SDNN (B: 0.18; 95% CI: 0.02, 0.35; R2 = 0.011). These associations remained significant after adjustment for confounding variables [RMSSD: B: 0.09; 95% CI: 0.003, 0.18; squared semipartial correlation (sp2) = 0.14 and SDNN B: 0.24; 95% CI: 0.0, 0.49; sp2 = 0.13]. CONCLUSIONS In a large cohort study, poorer prenatal diet quality was associated with lower offspring HRV, a marker of decreased capacity of the ANS to respond adaptively to challenge. Therefore, poor prenatal diet may play a significant role in the programming of multiple organ systems and could increase general susceptibility to disease in offspring.
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Affiliation(s)
- John E Krzeczkowski
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Khrista Boylan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Tye E Arbuckle
- Population Studies Division, Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada
| | - Gina Muckle
- School of Psychology, Université Laval, Quebec City, Quebec, Canada.,Research Centre of CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Natalia Poliakova
- Population Health and Optimal Health Practices Research Branch, CHU de Québec Research Centre, Quebec City, Quebec, Canada
| | - Jean R Séguin
- Department of Psychiatry and Addiction, CHU Ste-Justine Research Centre, Montreal, Quebec, Canada
| | - Lindsay A Favotto
- Department of Health Research Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Calan Savoy
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Bahar Amani
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Neda Mortaji
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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14
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Walton SL, Tjongue M, Tare M, Kwok E, Probyn M, Parkington HC, Bertram JF, Moritz KM, Denton KM. Chronic low alcohol intake during pregnancy programs sex-specific cardiovascular deficits in rats. Biol Sex Differ 2019; 10:21. [PMID: 31010438 PMCID: PMC6477739 DOI: 10.1186/s13293-019-0235-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 04/02/2019] [Indexed: 02/08/2023] Open
Abstract
Background Exposure to an adverse environment in early life can have lifelong consequences for risk of cardiovascular disease. Maternal alcohol (ethanol) intake is common and associated with a variety of harmful effects to the fetus. However, examining the effects on the cardiovascular system in adult offspring has largely been neglected. The objectives of this study were to investigate the influence of chronic, low ethanol consumption throughout pregnancy on blood pressure, vascular reactivity and wall stiffness, all key determinants of cardiovascular health, in both male and female rat offspring. Methods Female Sprague-Dawley rats were fed an ad libitum liquid diet ± 6% vol/vol ethanol throughout pregnancy. Male and female offspring were studied at 12 months of age. Arterial pressure, heart rate and locomotor activity were measured over 7 days via radiotelemetry. Renal lobar arteries were isolated and studied using wire and pressure myography. Results Basal mean arterial pressure in female ethanol-exposed rats was reduced by ~ 5–6 mmHg compared to control female offspring, whereas arterial pressure was unaffected in male offspring. Ethanol-exposed offspring had an attenuated pressor response to an acute restraint stress, with this effect most evident in females. Renal artery function was not affected by prenatal ethanol exposure. Conclusions We show for the first time that low level chronic maternal alcohol intake during pregnancy influences arterial pressure in adult offspring in the absence of fetal growth restriction. Electronic supplementary material The online version of this article (10.1186/s13293-019-0235-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah L Walton
- Cardiovascular Disease Program, Monash Biomedicine Discovery Institute, Clayton, VIC, Australia.,Department of Physiology, Monash University, Clayton, VIC, Australia
| | - Melissa Tjongue
- Cardiovascular Disease Program, Monash Biomedicine Discovery Institute, Clayton, VIC, Australia.,Department of Physiology, Monash University, Clayton, VIC, Australia
| | - Marianne Tare
- Department of Physiology, Monash University, Clayton, VIC, Australia.,Monash Rural Health, Churchill, VIC, Australia
| | - Edmund Kwok
- Cardiovascular Disease Program, Monash Biomedicine Discovery Institute, Clayton, VIC, Australia.,Department of Physiology, Monash University, Clayton, VIC, Australia
| | - Megan Probyn
- School of Biomedical Sciences, The University of Queensland, St Lucia, QLD, Australia
| | | | - John F Bertram
- Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia.,Kidney Developmental Programming and Disease Laboratory, Monash Biomedicine Discovery Institute, Clayton, VIC, Australia
| | - Karen M Moritz
- School of Biomedical Sciences, The University of Queensland, St Lucia, QLD, Australia.,Child Health Research Centre, The University of Queensland, St Lucia, QLD, Australia
| | - Kate M Denton
- Cardiovascular Disease Program, Monash Biomedicine Discovery Institute, Clayton, VIC, Australia. .,Department of Physiology, Monash University, Clayton, VIC, Australia.
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15
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Torres LH, Balestrin NT, Spelta LEW, Duro SDO, Pistis M, Marcourakis T. Exposure to tobacco smoke during the early postnatal period modifies receptors and enzymes of the endocannabinoid system in the brainstem and striatum in mice. Toxicol Lett 2019; 302:35-41. [DOI: 10.1016/j.toxlet.2018.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 11/19/2018] [Accepted: 12/12/2018] [Indexed: 01/31/2023]
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16
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Jones-Mason K, Alkon A, Coccia M, Bush NR. Autonomic nervous system functioning assessed during the Still-Face Paradigm: A meta-analysis and systematic review of methods, approach and findings. DEVELOPMENTAL REVIEW 2018; 50:113-139. [PMID: 33707809 DOI: 10.1016/j.dr.2018.06.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Animal and human research suggests that the development of the autonomic nervous system (ANS) is particularly sensitive to early parenting experiences. The Still-Face Paradigm (SFP), one of the most widely used measures to assess infant reactivity and emotional competence, evokes infant self-regulatory responses to parental interaction and disengagement. This systematic review of 33 peer-reviewed studies identifies patterns of parasympathetic (PNS) and sympathetic (SNS) nervous system activity demonstrated by infants under one year of age during the SFP and describes findings within the context of sample demographic characteristics, study methodologies, and analyses conducted. A meta-analysis of a subset of 14 studies with sufficient available respiratory sinus arrhythmia (RSA) data examined whether the SFP reliably elicited PNS withdrawal (RSA decrease) during parental disengagement or PNS recovery (RSA increase) during reunion, and whether results differed by socioeconomic status (SES). Across SES, the meta-analysis confirmed that RSA decreased during the still-face episode and increased during reunion. When studies were stratified by SES, low-SES or high-risk groups also showed RSA decreases during the still face episode but failed to show an increase in RSA during reunion. Few studies have examined SNS activity during the SFP to date, preventing conclusions in that domain. The review also identified multiple qualifications to patterns of SFP ANS findings, including those that differed by ethnicity, infant sex, parental sensitivity, and genetics. Strengths and weaknesses in the extant research that may explain some of the variation in findings across the literature are also discussed, and suggestions for strengthening future research are provided.
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Affiliation(s)
- Karen Jones-Mason
- Department of Psychiatry, Center for Health and Community, Weill Neurosciences Institute, University of California, San Francisco
| | - Abbey Alkon
- School of Nursing Department of Family Health Care Nursing, University of California, San Francisco
| | - Michael Coccia
- Department of Psychiatry, Center for Health and Community, Weill Neurosciences Institute, University of California, San Francisco
| | - Nicole R Bush
- Department of Psychiatry, Center for Health and Community, Weill Neurosciences Institute, University of California, San Francisco.,Department of Pediatrics, University of California, San Francisco
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17
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Vivekanandarajah A, Waters KA, Machaalani R. Cigarette smoke exposure effects on the brainstem expression of nicotinic acetylcholine receptors (nAChRs), and on cardiac, respiratory and sleep physiologies. Respir Physiol Neurobiol 2018; 259:1-15. [PMID: 30031221 DOI: 10.1016/j.resp.2018.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 12/15/2022]
Abstract
Cigarette smoking during pregnancy is the largest modifiable risk factor for adverse outcomes in the infant. Investigations have focused on the psychoactive component of cigarettes, nicotine. One proposed mechanism leading to adverse effects is the interaction between nicotine and its nicotinic acetylcholine receptors (nAChRs). Much data has been generated over the past three decades on the effects of cigarette smoke exposure (CSE) on the expression of the nAChRs in the brainstem and physiological parameters related to cardiac, respiration and sleep, in the offspring of smoking mothers and animal models of nicotine exposure. This review summarises this data and discusses the main findings, highlighting that findings in animal models closely correlate with those from human studies, and that the major brainstem sites where the expression level for the nAChRs are consistently affected include those that play vital roles in cardiorespiration (hypoglossal nucleus, dorsal motor nucleus of the vagus, nucleus of the solitary tract), chemosensation (nucleus of the solitary tract, arcuate nucleus) and arousal (rostral mesopontine sites such as the locus coeruleus and nucleus pontis oralis). These findings provide evidence for the adverse effects of CSE during and after pregnancy to the infant and the need to continue with the health campaign advising against CSE.
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Affiliation(s)
- Arunnjah Vivekanandarajah
- SIDS and Sleep Apnea Laboratory, Sydney Medical School, Medical Foundation Building K25, University of Sydney, NSW 2006, Australia.
| | - Karen A Waters
- SIDS and Sleep Apnea Laboratory, Sydney Medical School, Medical Foundation Building K25, University of Sydney, NSW 2006, Australia; Discipline of Paediatrics and Child Health, Children's Hospital Westmead, NSW, Australia
| | - Rita Machaalani
- SIDS and Sleep Apnea Laboratory, Sydney Medical School, Medical Foundation Building K25, University of Sydney, NSW 2006, Australia; Discipline of Paediatrics and Child Health, Children's Hospital Westmead, NSW, Australia
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18
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Eiden RD, Schuetze P, Shisler S, Huestis MA. Prenatal exposure to tobacco and cannabis: Effects on autonomic and emotion regulation. Neurotoxicol Teratol 2018; 68:47-56. [PMID: 29727701 PMCID: PMC6161361 DOI: 10.1016/j.ntt.2018.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/28/2018] [Accepted: 04/30/2018] [Indexed: 01/14/2023]
Abstract
Tobacco and cannabis are often used together in pregnancy and both have effects on children's regulatory system. Yet, little is known about the impact of co-use on the development of emotion regulation at the developmentally salient age of 2 years. One pathway linking co-exposure to tobacco and cannabis to toddler regulation may be via poor autonomic regulation in infancy. In addition, substance using mothers may be more dysregulated themselves, which may have direct effects on toddler regulation, but may also affect parenting, particularly maternal sensitivity during mother-child interactions. Thus, a second pathway linking exposure to toddler regulation may be via maternal dysregulation and low maternal sensitivity. We examined a conceptual model linking prenatal exposure to toddler regulation via these two pathways in a prospective sample (N = 247) of mother-child dyads recruited in the first trimester of pregnancy. Results indicated significant effects of co-exposure on poor autonomic regulation in infancy, which in turn predicted poor toddler emotion regulation. Mothers who used both tobacco and cannabis displayed lower sensitivity during play interactions with their infants. Maternal sensitivity was modestly stable from infant to toddler period and was predictive of higher toddler emotion regulation. Continued postnatal exposure to tobacco was also a significant, unique predictor of lower toddler emotion regulation. Results highlight the importance of examining co-exposure effects and suggest that this common pattern of use may be associated with higher infant/toddler risks.
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Affiliation(s)
- Rina D Eiden
- University at Buffalo, State University of New York.
| | - Pamela Schuetze
- State University of New York at Buffalo State, United States
| | | | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, Philadelphia, PA, United States
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19
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Lawrence WR, Yang M, Zhang C, Liu RQ, Lin S, Wang SQ, Liu Y, Ma H, Chen DH, Zeng XW, Yang BY, Hu LW, Yim SHL, Dong GH. Association between long-term exposure to air pollution and sleep disorder in Chinese children: the Seven Northeastern Cities study. Sleep 2018; 41:5043503. [DOI: 10.1093/sleep/zsy122] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Wayne R Lawrence
- Department of Preventive Medicine, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, NY
| | - Mo Yang
- Department of Preventive Medicine, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chuan Zhang
- Department of Preventive Medicine, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ru-Qing Liu
- Department of Preventive Medicine, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shao Lin
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, NY
| | - Si-Quan Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Yimin Liu
- Laboratory of Occupational Environment and Health Effects, Guangzhou Key Medical Discipline of Occupational Health Guardianship, Guangzhou Prevention and Treatment Center for Occupational Diseases, Guangzhou No.12 Hospital, Guangzhou, China
| | - Huimin Ma
- State Key Laboratory of Organic Geochemistry and Guangdong Key Laboratory of Environmental Protection and Resources Utilization, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Guangzhou, China
| | - Duo-Hong Chen
- Department of Air Quality Forecasting and Early Warning, Guangdong Environmental Monitoring Center, State Environmental Protection Key Laboratory of Regional Air Quality Monitoring, Guangdong Environmental Protection Key Laboratory of Atmospheric Secondary Pollution, Guangzhou, China
| | - Xiao-Wen Zeng
- Department of Preventive Medicine, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Bo-Yi Yang
- Department of Preventive Medicine, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li-Wen Hu
- Department of Preventive Medicine, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Steve Hung Lam Yim
- Department of Geography and Resource Management, Stanley Ho Big Data Decision Analytics Research Centre, Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Shatin N.T., Hong Kong, China
| | - Guang-Hui Dong
- Department of Preventive Medicine, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, School of Public Health, Sun Yat-sen University, Guangzhou, China
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20
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Abstract
Sudden infant death syndrome (SIDS) is the sudden unexpected death of an apparently healthy infant younger than age 12 months whose cause of death remains unknown despite a thorough death scene investigation, a review of the clinical history, and an autopsy. Despite the huge achievement of the Back to Sleep program, SIDS remains one of the leading causes of infant death in the United States. In recent years, the SIDS rate has remained stationary despite major public health efforts aimed at high-risk groups to improve sleep environment and strategies. This review focuses on SIDS epidemiology, pathogenesis and risk factors, the American Academy of Pediatrics recommendations on safe infant sleeping environment, and the US Centers for Disease Control and Prevention's multistate registry to improve knowledge on SIDS, evaluate trends, and analyze circumstances and events surrounding SIDS cases. [Pediatr Ann. 2018;47(3):e118-e123.].
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21
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van Deutekom AW, Chinapaw MJ, Gademan MG, Twisk JW, Gemke RJ, Vrijkotte TG. The association of birth weight and infant growth with childhood autonomic nervous system activity and its mediating effects on energy-balance-related behaviours-the ABCD study. Int J Epidemiol 2018; 45:1079-1090. [PMID: 27880695 DOI: 10.1093/ije/dyw236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to examine the association of birth weight and infant growth with childhood autonomic nervous system (ANS) activity and to assess whether ANS activity mediates the associations of birth weight and infant growth with energy-balance-related behaviours, including energy intake, satiety response, physical activity and screen time. METHODS In 2089 children, we prospectively collected birth weight, infant growth defined as conditional weight and height gain between birth and 12 months and-at 5 years-indices of cardiac ANS activity and parent-reported energy-balance-related behaviours. A mediation analysis was conducted, based on MacKinnon's multivariate extension of the product-of-coefficients strategy. RESULTS Birth weight and infant height gain were inversely associated with sympathetic, but not parasympathetic, activity at age 5. Infant weight gain was not associated with childhood ANS activity. Infant weight gain was predictive of increased childhood screen time and infant height gain of diminished childhood energy intake, but sympathetic activity did not mediate these associations. CONCLUSIONS Low-birth-weight children have higher sympathetic activity, which is considered a risk factor for cardiovascular disease. Height gain in infancy seems to be beneficial for childhood sympathetic activity. However, sympathetic activity was no mediator of the associations of infant growth with childhood energy-balance-related behaviours. As individual differences in ANS activity predict increased risk of cardiovascular disease, these differences may offer insight into the early-life origins of chronic diseases and provide further basis for public health strategies to optimize birth weight and infant growth.
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Affiliation(s)
- Arend W van Deutekom
- Department of Pediatrics, EMGO Institute for Health & Care Research, Institute for Cardiovascular Research VU, VU University Medical Center, Amsterdam, The Netherlands,
| | - Mai Jm Chinapaw
- Department of Public and Occupational Health, EMGO institute for Health & Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Maaike Gj Gademan
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands and
| | - Jos Wr Twisk
- Department of Epidemiology and Biostatistics, EMGO Institute for Health & Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Reinoud Jbj Gemke
- Department of Pediatrics, EMGO Institute for Health & Care Research, Institute for Cardiovascular Research VU, VU University Medical Center, Amsterdam, The Netherlands
| | - Tanja Gm Vrijkotte
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands and
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22
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Cardiovascular autonomic dysfunction in sudden infant death syndrome. Clin Auton Res 2018; 28:535-543. [PMID: 29299712 DOI: 10.1007/s10286-017-0490-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
Abstract
A failure of cardiorespiratory control mechanisms, together with an impaired arousal response from sleep, are believed to play an important role in the final event of sudden infant death syndrome (SIDS). The 'triple risk model' describes SIDS as an event that results from the intersection of three overlapping factors: (1) a vulnerable infant, (2) a critical developmental period in homeostatic control and (3) an exogenous stressor. In an attempt to understand how the triple risk hypothesis is related to infant cardiorespiratory physiology, many researchers have examined how the known risk and protective factors for SIDS alter infant cardiovascular control during sleep. This review discusses the association between the three components of the triple risk hypothesis and major risk factors for SIDS, such as prone sleeping, maternal smoking, together with three "protective" factors, and cardiovascular control during sleep in infants, and discusses their potential involvement in SIDS.
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23
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Siddiqui S, Fifer WP, Ordonez-Retamar M, Nugent JD, Williams IA. An antenatal marker of neurodevelopmental outcomes in infants with congenital heart disease. J Perinatol 2017; 37:953-957. [PMID: 28471442 PMCID: PMC5578909 DOI: 10.1038/jp.2017.59] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/23/2017] [Accepted: 03/31/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Prenatal exposures are known to alter fetal neurodevelopment and autonomic control. We aimed to explore the correlation between fetal autonomic activity, measured by fetal heart rate variability, and 18-month developmental outcome in subjects with congenital heart disease. STUDY DESIGN From 2010 to 2013, 5 fetuses with hypoplastic left heart syndrome, 9 with transposition of the great arteries and 9 with tetralogy of Fallot were included in this prospective cohort study. A maternal abdominal fetal electrocardiogram monitor recorded fetal heart rate at 34 to 38 weeks gestational age. We assessed associations between fetal heart rate parameters including interquartile range and s.d. of the fetal RR intervals and 18-month Bayley Scales of Infant Development-III scores using Pearson's correlation coefficient. Multivariable regression modeling identified predictors of neurodevelopmental scores. RESULTS Fetal heart rate variability parameters at 34 to 38 weeks gestational age correlated with 18-month Cognition (r=0.47, P=0.03) and Motor scores (r=0.66, P=0.001). The interquartile range of the fetal RR intervals predicted Cognition (β=0.462, P=0.028, R2=0.282) and Motor (β=0.637, P<0.001, R2=0.542) scores. CONCLUSIONS In fetuses with congenital heart disease, low heart rate variability at 34 to 38 weeks gestational age predicts diminished 18-month Cognitive and Motor performance. Prenatal autonomic activity may serve as a marker of early childhood development in these high-risk patients.
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Affiliation(s)
- Saira Siddiqui
- Department of Pediatrics, Columbia University Medical Center, New
York, NY
| | - William P. Fifer
- Department of Psychiatry, Columbia University Medical Center, New
York, NY
- Department of Pediatrics, Columbia University Medical Center, New
York, NY
- Division of Developmental Neuroscience, New York State Psychiatric
Institute, New York, NY
| | - Maria Ordonez-Retamar
- Division of Developmental Neuroscience, New York State Psychiatric
Institute, New York, NY
| | - J. David Nugent
- Division of Developmental Neuroscience, New York State Psychiatric
Institute, New York, NY
| | - Ismée A. Williams
- Department of Pediatrics, Columbia University Medical Center, New
York, NY
- Division of Developmental Neuroscience, New York State Psychiatric
Institute, New York, NY
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24
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Myers MM, Elliott AJ, Odendaal HJ, Burd L, Angal J, Groenewald C, Nugent JD, Yang JS, Isler JR, Dukes KA, Robinson F, Fifer WP. Cardiorespiratory physiology in the safe passage study: protocol, methods and normative values in unexposed infants. Acta Paediatr 2017; 106:1260-1272. [PMID: 28419567 DOI: 10.1111/apa.13873] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/03/2017] [Accepted: 04/10/2017] [Indexed: 11/27/2022]
Abstract
AIM The Safe Passage Study, conducted by the Prenatal Alcohol in SIDS and Stillbirth Network, is investigating contributions of prenatal alcohol exposure to foetal and infant demise. This current report presents physiological data from full-term infants with no prenatal exposure to alcohol or maternal smoking. METHODS Data are from 666 infants from the Northern Plains (North and South Dakota) and South Africa. A standardised protocol assessed cardiorespiratory function during baseline and head-up tilts shortly after birth and at one month of age. RESULTS Analyses revealed significant increases in heart rate and decreases in BP from the newborn to one-month time period as well as diminished heart rate responses to head-up tilt in one-month-old infants. CONCLUSION The Safe Passage Study was successful in characterising physiology in a large number of infants at sites known to have elevated risks for SIDS. Results demonstrate that even with low prenatal adverse exposures, there are significant changes in cardiorespiratory function as infants enter the window of increased risk for SIDS.
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Affiliation(s)
- Michael M. Myers
- Department of Psychiatry; Columbia University Medical Center; New York NY USA
- Department of Pediatrics; Columbia University Medical Center; New York NY USA
- Division of Developmental Neuroscience; New York State Psychiatric Institute; New York NY USA
| | - Amy J. Elliott
- Community and Population Health Sciences; Sanford Research; Sioux Falls SD USA
- Department of Pediatrics; Sanford School of Medicine; University of South Dakota; Sioux Falls SD USA
| | - Hein J. Odendaal
- Department of Obstetrics and Gynecology; Faculty of Medicine and Health Science; Stellenbosch University; Cape Town Western Cape South Africa
| | - Larry Burd
- University of North Dakota Medical School; Grand Forks ND USA
| | - Jyoti Angal
- Community and Population Health Sciences; Sanford Research; Sioux Falls SD USA
- Department of Pediatrics; Sanford School of Medicine; University of South Dakota; Sioux Falls SD USA
| | - Coen Groenewald
- Department of Obstetrics and Gynecology; Faculty of Medicine and Health Science; Stellenbosch University; Cape Town Western Cape South Africa
| | - James David Nugent
- Division of Developmental Neuroscience; New York State Psychiatric Institute; New York NY USA
| | - Joel S. Yang
- Division of Developmental Neuroscience; New York State Psychiatric Institute; New York NY USA
| | - Joseph R. Isler
- Department of Pediatrics; Columbia University Medical Center; New York NY USA
| | | | | | - William P. Fifer
- Department of Psychiatry; Columbia University Medical Center; New York NY USA
- Department of Pediatrics; Columbia University Medical Center; New York NY USA
- Division of Developmental Neuroscience; New York State Psychiatric Institute; New York NY USA
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25
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Kühne B, Genser B, De Bock F. Early determinants of vagal activity at preschool age - With potential dependence on sex. Early Hum Dev 2016; 103:167-174. [PMID: 27693723 DOI: 10.1016/j.earlhumdev.2016.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/15/2016] [Accepted: 09/15/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND In children, autonomic nervous function is related to various highly prevalent health problems and might therefore represent an early indicator of ill health. AIMS We aimed to investigate the role of early-life exposures and physical activity (PA) as potential determinants of autonomic function at preschool age. STUDY DESIGN AND SUBJECTS We used an existing longitudinal data set of repeated vagal tone measurements (assessed via heart rate recovery (HRR)) and retrospectively assessed early-life exposures in 1052 children (mean age: 59.4months, 47.5% girls) from 52 preschools in Germany recruited from 2008 to 2010. OUTCOME MEASURES HRR 1min after submaximal exercise served as primary outcome. Through multilevel linear regression analysis adjusted for demographic and socioeconomic factors, we assessed the association between repeatedly measured HRR and pregnancy smoking status, breastfeeding and objectively measured PA. RESULTS Besides significant regression coefficients for previously described correlates of HRR (sex, age), we could show positive associations of HRR with breastfeeding (six versus zero months: +4.2 beats per minute (BPM), p=0.004) and PA (+1.0BPM for 10min increase of moderate-to-vigorous PA/day, p<0.001). Smoking before and during pregnancy showed no significant association with HRR in the total sample. However, we found interactions between sex and smoking before and during pregnancy as well as between sex and breastfeeding, suggesting significant associations with HRR only in girls. CONCLUSIONS Besides PA, early pre- and postnatal exposures seem to have long-lasting effects on children's autonomic function, still recordable at preschool age. Our data suggest that these effects might be sex-dependent.
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Affiliation(s)
- Britta Kühne
- Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | - Bernd Genser
- Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany; Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil
| | - Freia De Bock
- Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany; Department of General Pediatrics, University Medicine Mannheim, Mannheim, Germany.
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Rabasco J, Vigo A, Vitelli O, Noce S, Pietropaoli N, Evangelisti M, Pia Villa M. Apparent life-threatening events could be a wake-up call for sleep disordered breathing. Pediatr Pulmonol 2016; 51:1403-1408. [PMID: 27163733 DOI: 10.1002/ppul.23468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/31/2016] [Accepted: 04/24/2016] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Polysomnographic recordings of children with an apparent life-threatening event (ALTE) have often displayed signs of partial or complete obstruction during sleep. Various studies have focused on facial dysmorphia in infants with ALTE and tried to establish a correlation between ALTE and obstructive sleep apnoea. Our study evaluates the phenotypic characteristics and the presence of sleep disorders in pre-school children who had at least one ALTE in the first year of life. MATERIALS AND METHODS We analyzed a group of pre-school children (mean age 5.21 ± 0.90 years) who were referred for an ALTE between 2008 and 2010. Children with no history of ALTEs were recruited as a control group. A detailed personal and family history was obtained for all the participants. Moreover, all the children underwent a general clinical examination and an ear, nose, and throat and orthodontic assessment. A clinical score was calculated according to the previously validated Sleep Clinical Record (SCR). RESULTS In the ALTE group (n = 107), snoring (25.2% vs. 6.1%), apnoeas (19.6% vs. 4.3%), restless sleep (31.7% vs. 6.1%), and habitual mouth breathing (35.5% vs. 12.2%, P < 0.05) were significantly more common (P < 0.05) than in the control group (n = 115). The ALTE group also displayed a higher frequency of Angle class II (27.1% vs. 15.7%, P < 0.05), narrow palate (72.9% vs. 51.3%, P < 0.05), and Friedman palate position (grades III-IV) (31.7% vs. 16.6%, P < 0.05) than the control group. Moreover, 38/107 (35.5%) children in the ALTE group had a positive SCR score compared with 14/115 controls (12.2%) (P < 0.05). CONCLUSIONS Pre-school age children with previous ALTE had a higher frequency of sleep disordered breathing and malocclusion phenotypes. The occurrence of ALTEs may be predictive of the development of sleep disordered breathing and highlight the importance of a long-term follow-up. Pediatr Pulmonol. 2016;51:1403-1408. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jole Rabasco
- Faculty of Medicine and Psychology, Department of Neuroscience, Mental Health and Sense Organs, Pediatric Sleep Disorder Centre, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Alessandro Vigo
- Center for Pediatric Sleep Medicine and SIDS, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Department of Pediatrics, University of Turin, Turin, Italy
| | - Ottavio Vitelli
- Faculty of Medicine and Psychology, Department of Neuroscience, Mental Health and Sense Organs, Pediatric Sleep Disorder Centre, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Silvia Noce
- Center for Pediatric Sleep Medicine and SIDS, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Department of Pediatrics, University of Turin, Turin, Italy
| | - Nicoletta Pietropaoli
- Faculty of Medicine and Psychology, Department of Neuroscience, Mental Health and Sense Organs, Pediatric Sleep Disorder Centre, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Melania Evangelisti
- Faculty of Medicine and Psychology, Department of Neuroscience, Mental Health and Sense Organs, Pediatric Sleep Disorder Centre, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Maria Pia Villa
- Faculty of Medicine and Psychology, Department of Neuroscience, Mental Health and Sense Organs, Pediatric Sleep Disorder Centre, Sant'Andrea Hospital, "Sapienza" University, Rome, Italy
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Moon RY. SIDS and Other Sleep-Related Infant Deaths: Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment. Pediatrics 2016; 138:peds.2016-2940. [PMID: 27940805 DOI: 10.1542/peds.2016-2940] [Citation(s) in RCA: 350] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Approximately 3500 infants die annually in the United States from sleep-related infant deaths, including sudden infant death syndrome (SIDS), ill-defined deaths, and accidental suffocation and strangulation in bed. After an initial decrease in the 1990s, the overall sleep-related infant death rate has not declined in more recent years. Many of the modifiable and nonmodifiable risk factors for SIDS and other sleep-related infant deaths are strikingly similar. The American Academy of Pediatrics recommends a safe sleep environment that can reduce the risk of all sleep-related infant deaths. Recommendations for a safe sleep environment include supine positioning, use of a firm sleep surface, room-sharing without bed-sharing, and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include avoidance of exposure to smoke, alcohol, and illicit drugs; breastfeeding; routine immunization; and use of a pacifier. New evidence and rationale for recommendations are presented for skin-to-skin care for newborn infants, bedside and in-bed sleepers, sleeping on couches/armchairs and in sitting devices, and use of soft bedding after 4 months of age. In addition, expanded recommendations for infant sleep location are included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, "SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment," which is included in this issue.
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28
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Raghuveer G, White DA, Hayman LL, Woo JG, Villafane J, Celermajer D, Ward KD, de Ferranti SD, Zachariah J. Cardiovascular Consequences of Childhood Secondhand Tobacco Smoke Exposure: Prevailing Evidence, Burden, and Racial and Socioeconomic Disparities: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e336-e359. [PMID: 27619923 PMCID: PMC5207215 DOI: 10.1161/cir.0000000000000443] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although public health programs have led to a substantial decrease in the prevalence of tobacco smoking, the adverse health effects of tobacco smoke exposure are by no means a thing of the past. In the United States, 4 of 10 school-aged children and 1 of 3 adolescents are involuntarily exposed to secondhand tobacco smoke (SHS), with children of minority ethnic backgrounds and those living in low-socioeconomic-status households being disproportionately affected (68% and 43%, respectively). Children are particularly vulnerable, with little control over home and social environment, and lack the understanding, agency, and ability to avoid SHS exposure on their own volition; they also have physiological or behavioral characteristics that render them especially susceptible to effects of SHS. Side-stream smoke (the smoke emanating from the burning end of the cigarette), a major component of SHS, contains a higher concentration of some toxins than mainstream smoke (inhaled by the smoker directly), making SHS potentially as dangerous as or even more dangerous than direct smoking. Compelling animal and human evidence shows that SHS exposure during childhood is detrimental to arterial function and structure, resulting in premature atherosclerosis and its cardiovascular consequences. Childhood SHS exposure is also related to impaired cardiac autonomic function and changes in heart rate variability. In addition, childhood SHS exposure is associated with clustering of cardiometabolic risk factors such as obesity, dyslipidemia, and insulin resistance. Individualized interventions to reduce childhood exposure to SHS are shown to be at least modestly effective, as are broader-based policy initiatives such as community smoking bans and increased taxation. PURPOSE The purpose of this statement is to summarize the available evidence on the cardiovascular health consequences of childhood SHS exposure; this will support ongoing efforts to further reduce and eliminate SHS exposure in this vulnerable population. This statement reviews relevant data from epidemiological studies, laboratory-based experiments, and controlled behavioral trials concerning SHS and cardiovascular disease risk in children. Information on the effects of SHS exposure on the cardiovascular system in animal and pediatric studies, including vascular disruption and platelet activation, oxidation and inflammation, endothelial dysfunction, increased vascular stiffness, changes in vascular structure, and autonomic dysfunction, is examined. CONCLUSIONS The epidemiological, observational, and experimental evidence accumulated to date demonstrates the detrimental cardiovascular consequences of SHS exposure in children. IMPLICATIONS Increased awareness of the adverse, lifetime cardiovascular consequences of childhood SHS may facilitate the development of innovative individual, family-centered, and community health interventions to reduce and ideally eliminate SHS exposure in the vulnerable pediatric population. This evidence calls for a robust public health policy that embraces zero tolerance of childhood SHS exposure.
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Haynes RL, Folkerth RD, Paterson DS, Broadbelt KG, Dan Zaharie S, Hewlett RH, Dempers JJ, Burger E, Wadee S, Schubert P, Wright C, Sens MA, Nelsen L, Randall BB, Tran H, Geldenhuys E, Elliott AJ, Odendaal HJ, Kinney HC. Serotonin Receptors in the Medulla Oblongata of the Human Fetus and Infant: The Analytic Approach of the International Safe Passage Study. J Neuropathol Exp Neurol 2016; 75:1048-1057. [PMID: 27634962 PMCID: PMC5070458 DOI: 10.1093/jnen/nlw080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Safe Passage Study is an international, prospective study of approximately 12 000 pregnancies to determine the effects of prenatal alcohol exposure (PAE) upon stillbirth and the sudden infant death syndrome (SIDS). A key objective of the study is to elucidate adverse effects of PAE upon binding to serotonin (5-HT) 1A receptors in brainstem homeostatic networks postulated to be abnormal in unexplained stillbirth and/or SIDS. We undertook a feasibility assessment of 5-HT1A receptor binding using autoradiography in the medulla oblongata (6 nuclei in 27 cases). 5-HT1A binding was compared to a reference dataset from the San Diego medical examiner’s system. There was no adverse effect of postmortem interval ≤100 h. The distribution and quantitated values of 5-HT1A binding in Safe Passage Study cases were essentially identical to those in the reference dataset, and virtually identical between stillbirths and live born fetal cases in grossly non-macerated tissues. The pattern of binding was present at mid-gestation with dramatic changes in binding levels in the medullary 5-HT nuclei over the second half of gestation; there was a plateau at lower levels in the neonatal period and into infancy. This study demonstrates feasibility of 5-HT1A binding analysis in the medulla in the Safe Passage Study.
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Affiliation(s)
- Robin L Haynes
- From the Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts (RLH, RDF, DSP, KGB, HT, HCK); Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (RDF); Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa ((SDZ, RHH, PS, EG); Division of Forensic Pathology and Medicine, Department of Pathology and Western Cape Forensic Pathology Services, Health Science Faculty, Stellenbosch University, Cape Town, South Africa (JJD, EB, SW); National Health Laboratory Services, Port Elizabeth, Eastern Cape, South Africa (CW); Department of Pathology, University of North Dakota, Grand Forks, North Dakota (MAS); Department of Pathology, University of South Dakota School of Medicine, Sioux Falls, South Dakota (LN, BBR); Community and Population Health Sciences, Sanford Research, Sioux Falls, South Dakota (AJE); Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa (HJO); The Prenatal Alcohol, SIDS, and Stillbirth (PASS) Research Network (PN)
| | - Rebecca D Folkerth
- From the Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts (RLH, RDF, DSP, KGB, HT, HCK); Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (RDF); Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa ((SDZ, RHH, PS, EG); Division of Forensic Pathology and Medicine, Department of Pathology and Western Cape Forensic Pathology Services, Health Science Faculty, Stellenbosch University, Cape Town, South Africa (JJD, EB, SW); National Health Laboratory Services, Port Elizabeth, Eastern Cape, South Africa (CW); Department of Pathology, University of North Dakota, Grand Forks, North Dakota (MAS); Department of Pathology, University of South Dakota School of Medicine, Sioux Falls, South Dakota (LN, BBR); Community and Population Health Sciences, Sanford Research, Sioux Falls, South Dakota (AJE); Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa (HJO); The Prenatal Alcohol, SIDS, and Stillbirth (PASS) Research Network (PN)
| | - David S Paterson
- From the Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts (RLH, RDF, DSP, KGB, HT, HCK); Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (RDF); Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa ((SDZ, RHH, PS, EG); Division of Forensic Pathology and Medicine, Department of Pathology and Western Cape Forensic Pathology Services, Health Science Faculty, Stellenbosch University, Cape Town, South Africa (JJD, EB, SW); National Health Laboratory Services, Port Elizabeth, Eastern Cape, South Africa (CW); Department of Pathology, University of North Dakota, Grand Forks, North Dakota (MAS); Department of Pathology, University of South Dakota School of Medicine, Sioux Falls, South Dakota (LN, BBR); Community and Population Health Sciences, Sanford Research, Sioux Falls, South Dakota (AJE); Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa (HJO); The Prenatal Alcohol, SIDS, and Stillbirth (PASS) Research Network (PN)
| | - Kevin G Broadbelt
- From the Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts (RLH, RDF, DSP, KGB, HT, HCK); Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (RDF); Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa ((SDZ, RHH, PS, EG); Division of Forensic Pathology and Medicine, Department of Pathology and Western Cape Forensic Pathology Services, Health Science Faculty, Stellenbosch University, Cape Town, South Africa (JJD, EB, SW); National Health Laboratory Services, Port Elizabeth, Eastern Cape, South Africa (CW); Department of Pathology, University of North Dakota, Grand Forks, North Dakota (MAS); Department of Pathology, University of South Dakota School of Medicine, Sioux Falls, South Dakota (LN, BBR); Community and Population Health Sciences, Sanford Research, Sioux Falls, South Dakota (AJE); Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa (HJO); The Prenatal Alcohol, SIDS, and Stillbirth (PASS) Research Network (PN)
| | - S Dan Zaharie
- From the Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts (RLH, RDF, DSP, KGB, HT, HCK); Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (RDF); Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa ((SDZ, RHH, PS, EG); Division of Forensic Pathology and Medicine, Department of Pathology and Western Cape Forensic Pathology Services, Health Science Faculty, Stellenbosch University, Cape Town, South Africa (JJD, EB, SW); National Health Laboratory Services, Port Elizabeth, Eastern Cape, South Africa (CW); Department of Pathology, University of North Dakota, Grand Forks, North Dakota (MAS); Department of Pathology, University of South Dakota School of Medicine, Sioux Falls, South Dakota (LN, BBR); Community and Population Health Sciences, Sanford Research, Sioux Falls, South Dakota (AJE); Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa (HJO); The Prenatal Alcohol, SIDS, and Stillbirth (PASS) Research Network (PN)
| | - Richard H Hewlett
- From the Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts (RLH, RDF, DSP, KGB, HT, HCK); Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (RDF); Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa ((SDZ, RHH, PS, EG); Division of Forensic Pathology and Medicine, Department of Pathology and Western Cape Forensic Pathology Services, Health Science Faculty, Stellenbosch University, Cape Town, South Africa (JJD, EB, SW); National Health Laboratory Services, Port Elizabeth, Eastern Cape, South Africa (CW); Department of Pathology, University of North Dakota, Grand Forks, North Dakota (MAS); Department of Pathology, University of South Dakota School of Medicine, Sioux Falls, South Dakota (LN, BBR); Community and Population Health Sciences, Sanford Research, Sioux Falls, South Dakota (AJE); Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa (HJO); The Prenatal Alcohol, SIDS, and Stillbirth (PASS) Research Network (PN)
| | - Johan J Dempers
- From the Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts (RLH, RDF, DSP, KGB, HT, HCK); Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (RDF); Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa ((SDZ, RHH, PS, EG); Division of Forensic Pathology and Medicine, Department of Pathology and Western Cape Forensic Pathology Services, Health Science Faculty, Stellenbosch University, Cape Town, South Africa (JJD, EB, SW); National Health Laboratory Services, Port Elizabeth, Eastern Cape, South Africa (CW); Department of Pathology, University of North Dakota, Grand Forks, North Dakota (MAS); Department of Pathology, University of South Dakota School of Medicine, Sioux Falls, South Dakota (LN, BBR); Community and Population Health Sciences, Sanford Research, Sioux Falls, South Dakota (AJE); Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa (HJO); The Prenatal Alcohol, SIDS, and Stillbirth (PASS) Research Network (PN)
| | - Elsie Burger
- From the Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts (RLH, RDF, DSP, KGB, HT, HCK); Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (RDF); Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa ((SDZ, RHH, PS, EG); Division of Forensic Pathology and Medicine, Department of Pathology and Western Cape Forensic Pathology Services, Health Science Faculty, Stellenbosch University, Cape Town, South Africa (JJD, EB, SW); National Health Laboratory Services, Port Elizabeth, Eastern Cape, South Africa (CW); Department of Pathology, University of North Dakota, Grand Forks, North Dakota (MAS); Department of Pathology, University of South Dakota School of Medicine, Sioux Falls, South Dakota (LN, BBR); Community and Population Health Sciences, Sanford Research, Sioux Falls, South Dakota (AJE); Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa (HJO); The Prenatal Alcohol, SIDS, and Stillbirth (PASS) Research Network (PN)
| | - Shabbir Wadee
- From the Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts (RLH, RDF, DSP, KGB, HT, HCK); Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (RDF); Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa ((SDZ, RHH, PS, EG); Division of Forensic Pathology and Medicine, Department of Pathology and Western Cape Forensic Pathology Services, Health Science Faculty, Stellenbosch University, Cape Town, South Africa (JJD, EB, SW); National Health Laboratory Services, Port Elizabeth, Eastern Cape, South Africa (CW); Department of Pathology, University of North Dakota, Grand Forks, North Dakota (MAS); Department of Pathology, University of South Dakota School of Medicine, Sioux Falls, South Dakota (LN, BBR); Community and Population Health Sciences, Sanford Research, Sioux Falls, South Dakota (AJE); Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa (HJO); The Prenatal Alcohol, SIDS, and Stillbirth (PASS) Research Network (PN)
| | - Pawel Schubert
- From the Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts (RLH, RDF, DSP, KGB, HT, HCK); Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (RDF); Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa ((SDZ, RHH, PS, EG); Division of Forensic Pathology and Medicine, Department of Pathology and Western Cape Forensic Pathology Services, Health Science Faculty, Stellenbosch University, Cape Town, South Africa (JJD, EB, SW); National Health Laboratory Services, Port Elizabeth, Eastern Cape, South Africa (CW); Department of Pathology, University of North Dakota, Grand Forks, North Dakota (MAS); Department of Pathology, University of South Dakota School of Medicine, Sioux Falls, South Dakota (LN, BBR); Community and Population Health Sciences, Sanford Research, Sioux Falls, South Dakota (AJE); Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa (HJO); The Prenatal Alcohol, SIDS, and Stillbirth (PASS) Research Network (PN)
| | - Colleen Wright
- From the Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts (RLH, RDF, DSP, KGB, HT, HCK); Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (RDF); Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa ((SDZ, RHH, PS, EG); Division of Forensic Pathology and Medicine, Department of Pathology and Western Cape Forensic Pathology Services, Health Science Faculty, Stellenbosch University, Cape Town, South Africa (JJD, EB, SW); National Health Laboratory Services, Port Elizabeth, Eastern Cape, South Africa (CW); Department of Pathology, University of North Dakota, Grand Forks, North Dakota (MAS); Department of Pathology, University of South Dakota School of Medicine, Sioux Falls, South Dakota (LN, BBR); Community and Population Health Sciences, Sanford Research, Sioux Falls, South Dakota (AJE); Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa (HJO); The Prenatal Alcohol, SIDS, and Stillbirth (PASS) Research Network (PN)
| | - Mary Ann Sens
- From the Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts (RLH, RDF, DSP, KGB, HT, HCK); Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (RDF); Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa ((SDZ, RHH, PS, EG); Division of Forensic Pathology and Medicine, Department of Pathology and Western Cape Forensic Pathology Services, Health Science Faculty, Stellenbosch University, Cape Town, South Africa (JJD, EB, SW); National Health Laboratory Services, Port Elizabeth, Eastern Cape, South Africa (CW); Department of Pathology, University of North Dakota, Grand Forks, North Dakota (MAS); Department of Pathology, University of South Dakota School of Medicine, Sioux Falls, South Dakota (LN, BBR); Community and Population Health Sciences, Sanford Research, Sioux Falls, South Dakota (AJE); Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa (HJO); The Prenatal Alcohol, SIDS, and Stillbirth (PASS) Research Network (PN)
| | - Laura Nelsen
- From the Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts (RLH, RDF, DSP, KGB, HT, HCK); Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (RDF); Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa ((SDZ, RHH, PS, EG); Division of Forensic Pathology and Medicine, Department of Pathology and Western Cape Forensic Pathology Services, Health Science Faculty, Stellenbosch University, Cape Town, South Africa (JJD, EB, SW); National Health Laboratory Services, Port Elizabeth, Eastern Cape, South Africa (CW); Department of Pathology, University of North Dakota, Grand Forks, North Dakota (MAS); Department of Pathology, University of South Dakota School of Medicine, Sioux Falls, South Dakota (LN, BBR); Community and Population Health Sciences, Sanford Research, Sioux Falls, South Dakota (AJE); Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa (HJO); The Prenatal Alcohol, SIDS, and Stillbirth (PASS) Research Network (PN)
| | - Bradley B Randall
- From the Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts (RLH, RDF, DSP, KGB, HT, HCK); Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (RDF); Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa ((SDZ, RHH, PS, EG); Division of Forensic Pathology and Medicine, Department of Pathology and Western Cape Forensic Pathology Services, Health Science Faculty, Stellenbosch University, Cape Town, South Africa (JJD, EB, SW); National Health Laboratory Services, Port Elizabeth, Eastern Cape, South Africa (CW); Department of Pathology, University of North Dakota, Grand Forks, North Dakota (MAS); Department of Pathology, University of South Dakota School of Medicine, Sioux Falls, South Dakota (LN, BBR); Community and Population Health Sciences, Sanford Research, Sioux Falls, South Dakota (AJE); Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa (HJO); The Prenatal Alcohol, SIDS, and Stillbirth (PASS) Research Network (PN)
| | - Hoa Tran
- From the Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts (RLH, RDF, DSP, KGB, HT, HCK); Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (RDF); Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa ((SDZ, RHH, PS, EG); Division of Forensic Pathology and Medicine, Department of Pathology and Western Cape Forensic Pathology Services, Health Science Faculty, Stellenbosch University, Cape Town, South Africa (JJD, EB, SW); National Health Laboratory Services, Port Elizabeth, Eastern Cape, South Africa (CW); Department of Pathology, University of North Dakota, Grand Forks, North Dakota (MAS); Department of Pathology, University of South Dakota School of Medicine, Sioux Falls, South Dakota (LN, BBR); Community and Population Health Sciences, Sanford Research, Sioux Falls, South Dakota (AJE); Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa (HJO); The Prenatal Alcohol, SIDS, and Stillbirth (PASS) Research Network (PN)
| | - Elaine Geldenhuys
- From the Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts (RLH, RDF, DSP, KGB, HT, HCK); Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (RDF); Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa ((SDZ, RHH, PS, EG); Division of Forensic Pathology and Medicine, Department of Pathology and Western Cape Forensic Pathology Services, Health Science Faculty, Stellenbosch University, Cape Town, South Africa (JJD, EB, SW); National Health Laboratory Services, Port Elizabeth, Eastern Cape, South Africa (CW); Department of Pathology, University of North Dakota, Grand Forks, North Dakota (MAS); Department of Pathology, University of South Dakota School of Medicine, Sioux Falls, South Dakota (LN, BBR); Community and Population Health Sciences, Sanford Research, Sioux Falls, South Dakota (AJE); Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa (HJO); The Prenatal Alcohol, SIDS, and Stillbirth (PASS) Research Network (PN)
| | - Amy J Elliott
- From the Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts (RLH, RDF, DSP, KGB, HT, HCK); Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (RDF); Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa ((SDZ, RHH, PS, EG); Division of Forensic Pathology and Medicine, Department of Pathology and Western Cape Forensic Pathology Services, Health Science Faculty, Stellenbosch University, Cape Town, South Africa (JJD, EB, SW); National Health Laboratory Services, Port Elizabeth, Eastern Cape, South Africa (CW); Department of Pathology, University of North Dakota, Grand Forks, North Dakota (MAS); Department of Pathology, University of South Dakota School of Medicine, Sioux Falls, South Dakota (LN, BBR); Community and Population Health Sciences, Sanford Research, Sioux Falls, South Dakota (AJE); Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa (HJO); The Prenatal Alcohol, SIDS, and Stillbirth (PASS) Research Network (PN)
| | - Hein J Odendaal
- From the Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts (RLH, RDF, DSP, KGB, HT, HCK); Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (RDF); Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa ((SDZ, RHH, PS, EG); Division of Forensic Pathology and Medicine, Department of Pathology and Western Cape Forensic Pathology Services, Health Science Faculty, Stellenbosch University, Cape Town, South Africa (JJD, EB, SW); National Health Laboratory Services, Port Elizabeth, Eastern Cape, South Africa (CW); Department of Pathology, University of North Dakota, Grand Forks, North Dakota (MAS); Department of Pathology, University of South Dakota School of Medicine, Sioux Falls, South Dakota (LN, BBR); Community and Population Health Sciences, Sanford Research, Sioux Falls, South Dakota (AJE); Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa (HJO); The Prenatal Alcohol, SIDS, and Stillbirth (PASS) Research Network (PN)
| | - Hannah C Kinney
- From the Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts (RLH, RDF, DSP, KGB, HT, HCK); Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (RDF); Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa ((SDZ, RHH, PS, EG); Division of Forensic Pathology and Medicine, Department of Pathology and Western Cape Forensic Pathology Services, Health Science Faculty, Stellenbosch University, Cape Town, South Africa (JJD, EB, SW); National Health Laboratory Services, Port Elizabeth, Eastern Cape, South Africa (CW); Department of Pathology, University of North Dakota, Grand Forks, North Dakota (MAS); Department of Pathology, University of South Dakota School of Medicine, Sioux Falls, South Dakota (LN, BBR); Community and Population Health Sciences, Sanford Research, Sioux Falls, South Dakota (AJE); Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Western Cape, South Africa (HJO); The Prenatal Alcohol, SIDS, and Stillbirth (PASS) Research Network (PN)
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Lucchini M, Fifer WP, Sahni R, Signorini MG. Novel heart rate parameters for the assessment of autonomic nervous system function in premature infants. Physiol Meas 2016; 37:1436-46. [PMID: 27480495 DOI: 10.1088/0967-3334/37/9/1436] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Autonomic nervous system (ANS) balance is a key factor in homeostatic control of cardiac activity, breathing and certain reflex reactions such as coughing, sneezing and swallowing and thus plays a crucial role for survival. ANS impairment has been related to many neonatal pathologies, including sudden infant death syndrome (SIDS). Moreover, some conditions have been identified as risk factors for SIDS, such as prone sleep position. There is an urgent need for timely and non-invasive assessment of ANS function in at-risk infants. Systematic measurement of heart rate variability (HRV) offers an optimal approach to access indirectly both sympathetic and parasympathetic influences on ANS functioning. In this paper, data from premature infants collected in a sleep physiology laboratory in the NICU are presented: traditional and novel approaches to HRV analyses are applied and compared in order to evaluate their relative merits in the assessment of ANS activity and the influence of sleep position. Indices from time domain and nonlinear approaches contributed as markers of physiological development in premature infants. Moreover, significant differences were observed as a function of sleep position.
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Affiliation(s)
- M Lucchini
- Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano, Italy
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31
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Lifelong Cardiovascular Adverse Effects of Childhood Tobacco Smoke Exposure. CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0508-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mak KK, Watanabe H, Nomachi S, Suganuma N. Nutritional Epidemiology of Antenatal Smoking Cessation Among Japanese Women. Nutr Cancer 2016; 68:396-403. [PMID: 27028702 DOI: 10.1080/01635581.2016.1152381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study compared the nutritional status before pregnancy, as well as dietary profiles and biomarkers during first trimester, between never-smokers and antenatal quitters among Japanese women. One hundred fifty pregnant women (79 never-smokers and 71 antenatal quitters) from two obstetrics and gynecology clinics were recruited in Japan. Subjects' prepregnancy nutritional status was indicated by their body mass index (BMI). In the first trimester, their dietary profiles were assessed by the Brief Diet-History Questionnaire (BDHQ) and pregnancy outcomes were screened by biomarker tests. Generalized linear regression was used to examine the differences of energy-adjusted dietary intakes and biomarker results between the two smoking groups, with adjustment of maternal age, BMI, gestation week, and parity. The results showed that antenatal quitters were more likely to have a prepregnancy underweight status than never-smokers. During the first trimester, antenatal quitters had significantly higher intakes of unsaturated fatty acids and antioxidants (vegetable lipids and isoflavone), and lower intakes of total cholesterol than never-smokers. Moreover, antenatal quitters had a significantly higher level of serum homocysteine (6.36 nmol/mL vs 4.88 nmol/mL) than never-smokers. In conclusion, antenatal quitters are more likely to have a poor nutritional status before pregnancy than never-smokers. Quitting smoking before pregnancy and having a good nutritional profile during the trimester may not sufficiently reverse the adverse effects of former smoking behaviors on pregnancy outcomes.
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Affiliation(s)
- Kwok-Kei Mak
- a Department of Epidemiology and Biostatistics , University of Texas Health Science Center at San Antonio , San Antonio , Texas , USA
| | - Hiroko Watanabe
- b Department of Children and Women's Health , Osaka University Graduate School of Medicine , Japan
| | - Shinobu Nomachi
- c Graduate School of Comprehensive Human Sciences , University of Tsukuba , Japan
| | - Nobuhiko Suganuma
- d Department of Human Health Sciences , Graduate School of Medicine, Kyoto University , Japan
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33
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Moon RY, Hauck FR. SIDS Risk: It's More Than Just the Sleep Environment. Pediatrics 2016; 137:peds.2015-3665. [PMID: 26634773 DOI: 10.1542/peds.2015-3665] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2015] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Fern R Hauck
- Family Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
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Abstract
Several lines of investigations have shown the deleterious effect of an alcohol on the autonomic nervous system. Recent evidence shows that infants exposed to alcohol during the antenatal period displayed aberration in the cardiac autonomic function after the birth. However, there is dearth of literature on the long term influence of antenatal alcohol exposure. In this study we measured the cardiac autonomic functions in children who were exposed to alcohol in the antenatal period and compared them with non-exposed control children. Twenty eight children (age: 9±2 years) in the antenatal alcohol exposed group and age, gender matched 30 non exposed healthy volunteers as a control (age: 10±2 years) were recruited. Electrocardiogram was recorded in all subjects at rest in the supine position. HRV parameters were analyzed in the time and frequency domains using customized software. The average heart rate was similar between both the groups. There was no statistical significant difference in the time domain measures between the groups. However, the low frequency power, normalized units and low frequency to high frequency ratio were significantly higher in the antenatal alcohol exposed children compared to the controls. This suggests sympathetic predominance in children who were exposed to alcohol in the antenatal period. In this study we provide evidence for the deleterious long lasting effect of antenatal exposure of alcohol on cardiac autonomic regulation. Further prospective studies are needed to confirm the causal relationship between antenatal alcohol exposure and autonomic dysregulation.
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Siddiqui S, Wilpers A, Myers M, Nugent JD, Fifer WP, Williams IA. Autonomic regulation in fetuses with congenital heart disease. Early Hum Dev 2015; 91:195-8. [PMID: 25662702 PMCID: PMC4821472 DOI: 10.1016/j.earlhumdev.2014.12.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 11/25/2014] [Accepted: 12/28/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Exposure to antenatal stressors affects autonomic regulation in fetuses. Whether the presence of congenital heart disease (CHD) alters the developmental trajectory of autonomic regulation is not known. AIMS/STUDY DESIGN This prospective observational cohort study aimed to further characterize autonomic regulation in fetuses with CHD; specifically hypoplastic left heart syndrome (HLHS), transposition of the great arteries (TGA), and tetralogy of Fallot (TOF). SUBJECTS From 11/2010 to 11/2012, 92 fetuses were enrolled: 41 controls and 51 with CHD consisting of 19 with HLHS, 12 with TGA, and 20 with TOF. Maternal abdominal fetal electrocardiogram (ECG) recordings were obtained at 3 gestational ages: 19-27 weeks (F1), 28-33 weeks (F2), and 34-38 weeks (F3). OUTCOME MEASURES Fetal ECG was analyzed for mean heart rate along with 3 measures of autonomic variability of the fetal heart rate: interquartile range, standard deviation, and root mean square of the standard deviation of the heart rate (RMSSD), a measure of parasympathetic activity. RESULTS During F1 and F2 periods, HLHS fetuses demonstrated significantly lower mean HR than controls (p<0.05). Heart rate variability at F3, as measured by standard deviation, interquartile range, and RMSSD was lower in HLHS than controls (p<0.05). Other CHD subgroups showed a similar, though non-significant trend towards lower variability. CONCLUSIONS Autonomic regulation in CHD fetuses differs from controls, with HLHS fetuses most markedly affected.
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Affiliation(s)
- Saira Siddiqui
- Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, New York, NY, USA
| | - Abigail Wilpers
- Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, New York, NY, USA
| | - Michael Myers
- NY State Psychiatric Institute, Department of Developmental Psychobiology, New York, NY, USA
| | - J. David Nugent
- NY State Psychiatric Institute, Department of Developmental Psychobiology, New York, NY, USA
| | - William P. Fifer
- NY State Psychiatric Institute, Department of Developmental Psychobiology, New York, NY, USA
| | - Ismée A. Williams
- Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Department of Pediatrics, New York, NY, USA
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36
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Dubois C, Kervern M, Naassila M, Pierrefiche O. Chronic ethanol exposure during development: Disturbances of breathing and adaptation. Respir Physiol Neurobiol 2013; 189:250-60. [DOI: 10.1016/j.resp.2013.06.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 06/20/2013] [Accepted: 06/20/2013] [Indexed: 12/11/2022]
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37
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Propper CB, Holochwost SJ. The influence of proximal risk on the early development of the autonomic nervous system. DEVELOPMENTAL REVIEW 2013. [DOI: 10.1016/j.dr.2013.05.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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38
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Jia X, Guo X, Li H, An X, Zhao Y. Characteristics and popular topics of latest researches into the effects of air particulate matter on cardiovascular system by bibliometric analysis. Inhal Toxicol 2013; 25:211-8. [PMID: 23480197 DOI: 10.3109/08958378.2013.775196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In recent years, many epidemiological and toxicological studies have investigated the adverse effects of air particulate matter (PM) on the cardiovascular system. However, it is difficult for the researchers to have a timely and effective overall command of the latest characteristics and popular topics in such a wide field. Different from the previous reviews, in which the research characteristics and trends are empirically concluded by experts, we try to have a comprehensive evaluation of the above topics for the first time by bibliometric analysis, a quantitative tool in information exploration. This study aims to introduce the bibliometric method into the field of PM and cardiovascular system. The articles were selected by searching PubMed/MEDLINE (from 2007 to 2012) using Medical Subject Headings (MeSH) terms "particulate matter" and "cardiovascular system". A total of 935 eligible articles and 1895 MeSH terms were retrieved and processed by the software Thomson Data Analyzer (TDA). The bibliographic information and the MeSH terms of these articles were classified and analyzed to summarize the research characteristics. The top 200 high-frequency MeSH terms (the cumulative frequency percentage was 74.2%) were clustered for popular-topic conclusion. We summarized the characteristics of published articles, of researcher collaborations and of the contents. Ten clusters of MeSH terms are presented. Six popular topics are concluded and elaborated for reference. Our study presents an overview of the characteristics and popular topics in the field of PM and cardiovascular system in the past five years by bibliometric tools, which may provide a new perspective for future researchers.
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Affiliation(s)
- Xiaofeng Jia
- Institute of Medical Information & Library, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China.
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39
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Taylor BE, Brundage CM. Chronic, but not acute, ethanol exposure impairs central hypercapnic ventilatory drive in bullfrog tadpoles. Respir Physiol Neurobiol 2013; 185:533-42. [DOI: 10.1016/j.resp.2012.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 10/29/2012] [Accepted: 11/12/2012] [Indexed: 11/25/2022]
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40
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Effects of active and passive tobacco cigarette smoking on heart rate variability. Int J Cardiol 2011; 163:109-15. [PMID: 22100604 DOI: 10.1016/j.ijcard.2011.10.140] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 10/21/2011] [Accepted: 10/30/2011] [Indexed: 01/13/2023]
Abstract
Given the widespread incidence of smoking as well as its deleterious health effects, it is crucial to examine practical and cost effective prognostic markers assessing its health impact. Heart rate variability (HRV) is a straightforward and cost effective technique to foresee health problems of cardiovascular nature and may be used to predict in advance smoking-induced health effects. In this review we evaluate the existing biological evidence regarding the effects of smoking on HRV and their associated cardiovascular consequences. In addition, we summarize fundamental information on the various HRV indicators and their diagnostic significance in relation to heart failure. An in depth analysis of the various HRV indices characterizing changes in the activation of the autonomic nervous system is provided together with a critical evaluation of all evidence published to date on the influence of chronic and acute active and passive smoking on HRV. Overall, the vast majority of published evidence suggests that acute and chronic active and passive smoking generate marked disruptions in the normal autonomic nervous system functioning characterized by increased sympathetic drive and reduced HRV and parasympathetic modulation. The proposed mechanisms that may generate this smoke-induced HRV reduction as well as its clinical implications are thoroughly evaluated.
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41
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Moon RY. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics 2011; 128:e1341-67. [PMID: 22007003 DOI: 10.1542/peds.2011-2285] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Despite a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed for sleep in a nonprone position, this decline has plateaued in recent years. Concurrently, other causes of sudden unexpected infant death occurring during sleep (sleep-related deaths), including suffocation, asphyxia, and entrapment, and ill-defined or unspecified causes of death have increased in incidence, particularly since the AAP published its last statement on SIDS in 2005. It has become increasingly important to address these other causes of sleep-related infant death. Many of the modifiable and nonmodifiable risk factors for SIDS and suffocation are strikingly similar. The AAP, therefore, is expanding its recommendations from being only SIDS-focused to focusing on a safe sleep environment that can reduce the risk of all sleep-related infant deaths including SIDS. The recommendations described in this report include supine positioning, use of a firm sleep surface, breastfeeding, room-sharing without bed-sharing, routine immunization, consideration of a pacifier, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs. The rationale for these recommendations is discussed in detail in this technical report. The recommendations are published in the accompanying "Policy Statement--Sudden Infant Death Syndrome and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment," which is included in this issue (www.pediatrics.org/cgi/doi/10.1542/peds.2011-2220).
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Huijbregts SCJ, van Berkel SR, Swaab-Barneveld H, van Goozen SHM. Neurobiological and behavioral stress reactivity in children prenatally exposed to tobacco. Psychoneuroendocrinology 2011; 36:913-8. [PMID: 21255938 DOI: 10.1016/j.psyneuen.2010.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 12/14/2010] [Accepted: 12/16/2010] [Indexed: 11/15/2022]
Abstract
This study examined neurobiological and behavioral stress reactivity in children who had been prenatally exposed to tobacco. Neurobiological stress reactivity was measured using salivary cortisol and alpha-amylase levels at five different time points throughout a stressful neuropsychological test session, which involved a competition against a videotaped opponent. Participants (mean age: 10.6 years, SD 1.3) were 14 prenatally exposed (PE) children, 9 children with disruptive behavior problems (DBD), and 15 normal controls (NC). For cortisol responses, no significant differences between the three groups were observed. Normal controls, however, had significantly higher alpha-amylase levels than PE-children throughout the test session, and their alpha-amylase levels also increased throughout the session, whereas these remained low and stable for PE-children. Alpha-amylase levels and trajectory of PE-children were similar to those observed for DBD-children. PE-children also showed significantly increased behavioral stress reactivity compared to NC-children, and neurobiological and behavioral stress reactivity were inversely related in PE-children, again similar to what was observed for DBD-children. These results support the hypothesis that prenatal smoking may lead to long-lasting neurobiological and behavioral changes in exposed offspring.
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Affiliation(s)
- Stephan C J Huijbregts
- Leiden University, Faculty of Social Sciences, Department of Clinical Child and Adolescent Studies, Leiden, The Netherlands.
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Schneider ML, Moore CF, Adkins MM. The effects of prenatal alcohol exposure on behavior: rodent and primate studies. Neuropsychol Rev 2011; 21:186-203. [PMID: 21499982 PMCID: PMC4226068 DOI: 10.1007/s11065-011-9168-8] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 04/03/2011] [Indexed: 01/30/2023]
Abstract
The use of alcohol by women during pregnancy is a continuing problem. In this review the behavioral effects of prenatal alcohol from animal models are described and related to studies of children and adults with FASD. Studies with monkeys and rodents show that prenatal alcohol exposure adversely affects neonatal orienting, attention and motor maturity, as well as activity level, executive function, response inhibition, and sensory processing later in life. The primate moderate dose behavioral findings fill an important gap between human correlational data and rodent mechanistic research. These animal findings are directly translatable to human findings. Moreover, primate studies that manipulated prenatal alcohol exposure and prenatal stress independently show that prenatal stress exacerbates prenatal alcohol-induced behavioral impairments, underscoring the need to consider stress-induced effects in fetal alcohol research. Studies in rodents and primates show long-term effects of prenatal and developmental alcohol exposure on dopamine system functioning, which could underpin the behavioral effects.
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Affiliation(s)
- Mary L Schneider
- Harlow Center for Biological Psychology, University of Wisconsin-Madison, Madison, WI 53715, USA.
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Yiallourou SR, Sands SA, Walker AM, Horne RSC. Baroreflex sensitivity during sleep in infants: impact of sleeping position and sleep state. Sleep 2011; 34:725-32. [PMID: 21629360 DOI: 10.5665/sleep.1036] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES The prone sleeping position is a major risk for the sudden infant death syndrome (SIDS) and has been associated with lowered blood pressure and impaired blood pressure control. This study aimed to assess the effects of sleeping position, sleep state, and postnatal age on baroreflex control of heart rate. PARTICIPANTS Term infants (n = 31) were studied at 2-4 weeks, 2-3 months, and 5-6 months with daytime polysomnography. INTERVENTIONS Blood pressure and heart rate were recorded during quiet (QS) and active (AS) sleep in both the supine and prone positions. In each condition, three 1-2 minute baseline measurements and three 15° head-up tilts were performed. MEASUREMENTS AND RESULTS Baroreflex sensitivity (BRS) was assessed using cross-spectral analysis (BRS(SP)) and sequence analysis (BRS(SEQ)) in the baseline condition and with BRS(SP) during head-up tilting (BRS(SP) Tilt). BRS was usually lower prone compared to supine, reaching significance at 2-3 months (BRS(SP), P < 0.05; BRS(SP) Tilt, P < 0.05) and 5-6 months (BRS(SEQ), P < 0.05). BRS was lower in AS than QS supine at 5-6 months for all BRS estimates (P < 0.05). During QS, BRS increased with postnatal age in both sleeping positions (P < 0.05 for all BRS estimates); during AS, the postnatal age-related increase was limited to the prone position (BRS(SEQ), P < 0.05). CONCLUSIONS Sleeping position, sleep state and postnatal age all affect infant baroreflex function. Reduced BRS in the younger infants sleeping prone could increase the vulnerability to hypotensive events during sleep and thus play a vital role in conditions where circulatory failure may be involved, such as SIDS.
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Affiliation(s)
- Stephanie R Yiallourou
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
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Kinney HC, Broadbelt KG, Haynes RL, Rognum IJ, Paterson DS. The serotonergic anatomy of the developing human medulla oblongata: implications for pediatric disorders of homeostasis. J Chem Neuroanat 2011; 41:182-99. [PMID: 21640183 DOI: 10.1016/j.jchemneu.2011.05.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 04/25/2011] [Accepted: 05/06/2011] [Indexed: 12/18/2022]
Abstract
The caudal serotonergic (5-HT) system is a critical component of a medullary "homeostatic network" that regulates protective responses to metabolic stressors such as hypoxia, hypercapnia, and hyperthermia. We define anatomically the caudal 5-HT system in the human medulla as 5-HT neuronal cell bodies located in the raphé (raphé obscurus, raphé magnus, and raphé pallidus), extra-raphé (gigantocellularis, paragigantocellularis lateralis, intermediate reticular zone, lateral reticular nucleus, and nucleus subtrigeminalis), and ventral surface (arcuate nucleus). These 5-HT neurons are adjacent to all of the respiratory- and autonomic-related nuclei in the medulla where they are positioned to modulate directly the responses of these effector nuclei. In the following review, we highlight the topography and development of the caudal 5-HT system in the human fetus and infant, and its inter-relationships with nicotinic, GABAergic, and cytokine receptors. We also summarize pediatric disorders in early life which we term "developmental serotonopathies" of the caudal (as well as rostral) 5-HT domain and which are associated with homeostatic imbalances. The delineation of the development and organization of the human caudal 5-HT system provides the critical foundation for the neuropathologic elucidation of its disorders directly in the human brain.
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Affiliation(s)
- Hannah C Kinney
- Department of Pathology, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, United States
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Slotkin TA, Seidler FJ, Spindel ER. Prenatal nicotine exposure in rhesus monkeys compromises development of brainstem and cardiac monoamine pathways involved in perinatal adaptation and sudden infant death syndrome: amelioration by vitamin C. Neurotoxicol Teratol 2011; 33:431-4. [PMID: 21320590 DOI: 10.1016/j.ntt.2011.02.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 02/01/2011] [Accepted: 02/03/2011] [Indexed: 10/18/2022]
Abstract
Maternal smoking during pregnancy greatly enhances perinatal morbidity/mortality and is the major risk factor for Sudden Infant Death Syndrome (SIDS). Studies in developing rodents indicate that nicotine is a neuroteratogen that targets monoamine pathways involved in the responses to hypoxia that are in turn, hypothesized to contribute to these adverse events. We administered nicotine to pregnant Rhesus monkeys from gestational day 30 through 160 by continuous infusion, achieving maternal plasma levels comparable to those in smokers; we examined neurochemical parameters immediately after Cesarean delivery at the end of the exposure period. Nicotine evoked elevations in brainstem serotonin levels and serotonin turnover, indicating hyperactivity of these pathways. The same treatment evoked a deficit in cardiac norepinephrine levels. Both effects were offset by coadministration of the antioxidant, Vitamin C. Brainstem serotonin hyperinnervation is a hallmark of SIDS, and the hyperactivity seen here can also account for the downregulation of serotonin receptors noted in this disorder. Deficient cardiac sympathetic innervation is also consistent with increased vulnerability to hypoxia during delivery or in the agonal event in SIDS. Our results thus indicate that nicotine exposure in a primate model produces brainstem and autonomic abnormalities of the key monoamine systems that govern the response to hypoxia, indicate an important role of oxidative stress in the adverse effects, and point to potential amelioration strategies that could offset these particular effects of nicotine.
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Affiliation(s)
- Theodore A Slotkin
- Department of Pharmacology & Cancer Biology, Duke University Medical Center, Durham, NC 27710, United States.
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Horne RSC, Witcombe NB, Yiallourou SR, Scaillet S, Thiriez G, Franco P. Cardiovascular control during sleep in infants: Implications for Sudden Infant Death Syndrome. Sleep Med 2010; 11:615-21. [PMID: 20609624 DOI: 10.1016/j.sleep.2009.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 10/22/2009] [Accepted: 10/22/2009] [Indexed: 10/19/2022]
Abstract
In infants the cardiorespiratory system undergoes significant functional maturation after birth and these changes are sleep-state dependent. Given the immaturity of these systems it is not surprising that infants are at risk of cardiorespiratory instability, especially during sleep. A failure of cardiovascular control mechanisms in particular is believed to play a role in the final event of Sudden Infant Death Syndrome (SIDS). The "triple risk model" describes SIDS as an event that results from the intersection of three overlapping factors: (1) a vulnerable infant, (2) a critical development period in homeostatic control, and (3) an exogenous stressor. This review summarises normal development of cardiovascular control during sleep in infants and describes the association of impaired cardiovascular control with the three overlapping factors proposed to be involved in SIDS pathogenesis.
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Affiliation(s)
- Rosemary S C Horne
- Ritchie Centre for Baby Health Research, Monash Institute of Medical Research, Monash University, Melbourne, Australia.
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Oberlander TF, Jacobson SW, Weinberg J, Grunau RE, Molteno CD, Jacobson JL. Prenatal alcohol exposure alters biobehavioral reactivity to pain in newborns. Alcohol Clin Exp Res 2010; 34:681-92. [PMID: 20121718 DOI: 10.1111/j.1530-0277.2009.01137.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine biobehavioral responses to an acute pain event in a Cape Town, South Africa, cohort consisting of 28 Cape Colored (mixed ancestry) newborns (n = 14) heavily exposed to alcohol during pregnancy (exposed), and born to abstainers (n = 14) or light (< or = 0.5 oz absolute alcohol/d) drinkers (controls). METHODS Mothers were recruited during the third trimester of pregnancy. Newborn data were collected on postpartum day 3 in the maternity obstetrical unit where the infant had been delivered. Heavy prenatal alcohol exposure was defined as maternal consumption of at least 14 drinks/wk or at least 1 incident of binge drinking/mo. Acute stress-related biobehavioral markers [salivary cortisol, heart rate (HR), respiratory sinus arrhythmia (RSA), spectral measures of heart rate variability (HRV), and videotaped facial actions] were collected thrice during a heel lance blood collection (baseline, lance, and recovery). After a feeding and nap, newborns were administered an abbreviated Brazelton Neonatal Behavioral Assessment Scale. RESULTS There were no between-group differences in maternal age, marital status, parity, gravidity, depression, anxiety, pregnancy smoking, maternal education, or infant gestational age at birth (all ps > 0.15). In both groups, HR increased with the heel lance and decreased during the postlance period. The alcohol-exposed group had lower mean HR than controls throughout, and showed no change in RSA over time. Cortisol levels showed no change over time in controls but decreased over time in exposed infants. Although facial action analyses revealed no group differences in response to the heel lance, behavioral responses assessed on the Brazelton Neonatal Scale showed less arousal in the exposed group. CONCLUSIONS Both cardiac autonomic and hypothalamic-pituitary-adrenal stress reactivity measures suggest a blunted response to an acute noxious event in alcohol-exposed newborns. This is supported by results on the Brazelton Neonatal Scale indicating reduced behavioral arousal in the exposed group. To our knowledge, these data provide the first biobehavioral examination of early pain reactivity in alcohol-exposed newborns and have important implications for understanding neuro-/biobehavioral effects of prenatal alcohol exposure in the newborn period.
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Affiliation(s)
- Tim F Oberlander
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
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Matsunaga T, Gu N, Yamazaki H, Adachi T, Yasuda K, Moritani T, Tsuda K, Nishiyama T, Nonaka M. Association of estrogen receptor-alpha gene polymorphisms with cardiac autonomic nervous activity in healthy young Japanese males. Clin Chim Acta 2010; 411:505-9. [PMID: 20060387 DOI: 10.1016/j.cca.2009.12.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Revised: 12/24/2009] [Accepted: 12/28/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Estrogens exert beneficial effects on the cardiovascular system that are mediated by estrogen receptors. We examined the association between the estrogen receptor alpha gene (ESR1) PvuII and XbaI polymorphisms and cardiac autonomic nervous function in Japanese males. METHODS We examined 252 young healthy males for association of ESR1 PvuII and XbaI polymorphisms and short-term heart rate variability (HRV) during supine rest and in a standing position. The very low frequency (VLF), low frequency (LF), and high frequency (HF) components of HRV were quantified by frequency domain analysis. RESULTS Carriers of the ESR1 PvuII C allele had higher mean blood pressure (BP), while the XbaI GG genotype was significantly associated with higher diastolic and mean BP, but lower HR. In the haplotype analysis, carriers of the ESR1 haplotype 2 (PvuII C and XbaI A) allele had a higher systolic and mean BP, and lower HRV spectral powers (total power, VLF, LF, and HF components) in a supine rest compared with those of non-carriers. CONCLUSIONS The ESR1 PvuII and XbaI haplotype is associated with BP variation and the reduction in cardiac autonomic nervous activity in young Japanese males, which may be precursors of future pathological episodes of cardiovascular diseases.
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Thayer JF, Yamamoto SS, Brosschot JF. The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. Int J Cardiol 2009; 141:122-31. [PMID: 19910061 DOI: 10.1016/j.ijcard.2009.09.543] [Citation(s) in RCA: 1305] [Impact Index Per Article: 87.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 09/09/2009] [Indexed: 12/12/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. The understanding of the risk factors for CVD may yield important insights into the prevention, etiology, course, and treatment of this major public health concern. Autonomic imbalance, characterized by a hyperactive sympathetic system and a hypoactive parasympathetic system, is associated with various pathological conditions. Over time, excessive energy demands on the system can lead to premature aging and diseases. Therefore, autonomic imbalance may be a final common pathway to increased morbidity and mortality from a host of conditions and diseases, including cardiovascular disease. Heart rate variability (HRV) may be used to assess autonomic imbalances, diseases and mortality. Parasympathetic activity and HRV have been associated with a wide range of conditions including CVD. Here we review the evidence linking HRV to established and emerging modifiable and non-modifiable CVD risk factors such as hypertension, obesity, family history and work stress. Substantial evidence exists to support the notion that decreased HRV precedes the development of a number of risk factors and that lowering risk profiles is associated with increased HRV. We close with a suggestion that a model of autonomic imbalance may provide a unifying framework within which to investigate the impact of risk factors, including psychosocial factors and work stress, on cardiovascular disease.
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Affiliation(s)
- Julian F Thayer
- The Ohio State University, Department of Psychology, 1835 Neil Avenue, Columbus, Ohio 43210, USA.
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