1
|
Govindan RB, Andescavage NN, Basu S, Murnick J, Ngwa J, Galla JT, Kapse K, Limperopoulos C, du Plessis A. Circadian rhythm development in preterm infants. The role of postnatal versus postmenstrual age. Early Hum Dev 2024; 196:106084. [PMID: 39126762 DOI: 10.1016/j.earlhumdev.2024.106084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND, AIMS Circadian rhythm maturation may be disturbed in premature infants undergoing neonatal intensive care. We used continuous heart rate recordings across the entire neonatal intensive care period to study circadian rhythm development in preterm infants and to evaluate the roles of postmenstrual (PMA) versus postnatal age (PNA). MATERIALS AND METHODS The circadian rhythm was calculated using a cosine fit of heart rate. The circadian rhythm amplitudes were averaged weekly and studied relative to PMA and PNA using the linear mixed effects models, adjusting for clinical variables that could affect the heart rate. The daily circadian rhythms were used to create grand averages for PMA groups: ≤31, 32-35, and > 35 weeks, and for PNA groups: ≤30, 31-60, and > 60 days. RESULTS Sixty-six infants were evaluated as part of an ongoing prospective study with gestational ages between 23 and 36 weeks. The PMA (1.47 × 10-2 beats per minute (bpm)/week, P = 2.07 × 10-8) and PNA (1.87 × 10-2 bpm/day; P = 1.86 × 10-6) were significantly associated with the circadian rhythm amplitude independent of covariates. Infants ≤31 weeks' PMA and ≤30 days PNA, the phase of circadian rhythm amplitude grand averages showed a peak at night and a nadir during the day. Hereafter the circadian rhythm phase reversed to that established for mature individuals. The highest circadian rhythm amplitudes present >35 weeks' PMA and > 60 days PNA. CONCLUSIONS Our results indicate circadian rhythm matures with advancing gestation. The reversed circadian rhythm phase during the early postnatal period could be due to premature exposure to the ex-utero environment and warrant further study.
Collapse
Affiliation(s)
- R B Govindan
- The Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA; The Developing Brain Institute, Children's National Hospital, Washington, DC, USA; Department of Pediatrics, The George Washington University School of Medicine, Washington, DC, USA.
| | - Nickie N Andescavage
- Department of Pediatrics, The George Washington University School of Medicine, Washington, DC, USA; Division of Neonatology, Children's National Hospital, Washington, DC, USA
| | - Sudeepta Basu
- Department of Pediatrics, The George Washington University School of Medicine, Washington, DC, USA; Division of Neonatology, Children's National Hospital, Washington, DC, USA
| | - Jonathan Murnick
- Division of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, DC, USA
| | - Julius Ngwa
- The Developing Brain Institute, Children's National Hospital, Washington, DC, USA
| | - Jeffrey T Galla
- The Developing Brain Institute, Children's National Hospital, Washington, DC, USA
| | - Kushal Kapse
- The Developing Brain Institute, Children's National Hospital, Washington, DC, USA
| | - Catherine Limperopoulos
- The Developing Brain Institute, Children's National Hospital, Washington, DC, USA; Department of Pediatrics, The George Washington University School of Medicine, Washington, DC, USA
| | - Adre du Plessis
- The Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA; The Developing Brain Institute, Children's National Hospital, Washington, DC, USA; Department of Pediatrics, The George Washington University School of Medicine, Washington, DC, USA; Department of Neurology School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| |
Collapse
|
2
|
Kota S. ECI biocommentary: Srinivas Kota. Pediatr Res 2024:10.1038/s41390-024-03392-0. [PMID: 39039328 DOI: 10.1038/s41390-024-03392-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/21/2024] [Indexed: 07/24/2024]
Affiliation(s)
- Srinivas Kota
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA.
| |
Collapse
|
3
|
Pedersen MV, Andelius TCK, Andersen HB, Kyng KJ, Henriksen TB. Hypothermia and heart rate variability in a healthy newborn piglet model. Sci Rep 2022; 12:18282. [PMID: 36316356 PMCID: PMC9622714 DOI: 10.1038/s41598-022-22426-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022] Open
Abstract
Decreased heart rate variability (HRV) may be a biomarker of brain injury severity in neonatal hypoxic-ischemic encephalopathy for which therapeutic hypothermia is standard treatment. While therapeutic hypothermia may influence the degree of brain injury; hypothermia may also affect HRV per se and obscure a potential association between HRV and hypoxic-ischemic encephalopathy. Previous results are conflicting. This study aimed to investigate the effect of hypothermia on HRV in healthy, anaesthetised, newborn piglets. Six healthy newborn piglets were anaesthetised. Three piglets were first kept normothermic (38.5-39.0 °C) for 3 h, then exposed to hypothermia (33.5-34.5 °C) for 3 h. Three piglets were first exposed to hypothermia for 3 h, then rewarmed to normothermia for 3 h. Temperature and ECG were recorded continuously. HRV was calculated from the ECG in 5 min epochs and included time domain and frequency domain variables. The HRV variables were compared between hypothermia and normothermia. All assessed HRV variables were higher during hypothermia compared to normothermia. Heart rate was lower during hypothermia compared to normothermia and all HRV variables correlated with heart rate. Hypothermia was associated with an increase in HRV; this could be mediated by bradycardia during hypothermia.
Collapse
Affiliation(s)
- Mette Vestergård Pedersen
- grid.154185.c0000 0004 0512 597XDepartment of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus N, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 99, Aarhus N, Denmark
| | - Ted Carl Kejlberg Andelius
- grid.154185.c0000 0004 0512 597XDepartment of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus N, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 99, Aarhus N, Denmark
| | - Hannah Brogård Andersen
- grid.154185.c0000 0004 0512 597XDepartment of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus N, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 99, Aarhus N, Denmark
| | - Kasper Jacobsen Kyng
- grid.154185.c0000 0004 0512 597XDepartment of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus N, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 99, Aarhus N, Denmark
| | - Tine Brink Henriksen
- grid.154185.c0000 0004 0512 597XDepartment of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus N, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 99, Aarhus N, Denmark
| |
Collapse
|
4
|
Schlatterer SD, Govindan RB, Barnett SD, Al-Shargabi T, Reich DA, Iyer S, Hitchings L, Larry Maxwell G, Baker R, du Plessis AJ, Mulkey SB. Autonomic development in preterm infants is associated with morbidity of prematurity. Pediatr Res 2022; 91:171-177. [PMID: 33654284 PMCID: PMC7922721 DOI: 10.1038/s41390-021-01420-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/05/2021] [Accepted: 02/02/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies have described an association between preterm birth and maturation of the autonomic nervous system (ANS); however, this may be impacted by multiple factors, including prematurity-related complications. Our aim was to evaluate for the effect of prematurity-related morbidity on ANS development in preterm infants in the NICU. METHODS We compared time and frequency domains of heart rate variability (HRV) as a measure of ANS tone in 56 preterm infants from 2 NICUs (28 from each). One cohort was from a high-morbidity regional referral NICU, the other from a community-based inborn NICU with low prematurity-related morbidity. Propensity score matching was used to balance the groups by a 1:1 nearest neighbor design. ANS tone was analyzed. RESULTS The two cohorts showed parallel maturational trajectory of the alpha 1 time-domain metric, with the cohort from the high-morbidity NICU having lower autonomic tone. The maturational trajectories between the two cohorts differed in all other time-domain metrics (alpha 2, RMS1, RMS2). There was no difference between groups by frequency-domain metrics. CONCLUSIONS Prematurity-associated morbidities correlate with autonomic development in premature infants and may have a greater impact on the extrauterine maturation of this system than birth gestational age. IMPACT Autonomic nervous system development measured by time-domain metrics of heart rate variability correlate with morbidities associated with premature birth. This study builds upon our previously published work that showed that development of autonomic tone was not impacted by gestational age at birth. This study adds to our understanding of autonomic nervous system development in a preterm extrauterine environment. Our study suggests that gestational age at birth may have less impact on autonomic nervous system development than previously thought.
Collapse
Affiliation(s)
- Sarah D. Schlatterer
- grid.239560.b0000 0004 0482 1586Children’s National Hospital, Prenatal Pediatrics Institute, Washington, DC USA ,grid.253615.60000 0004 1936 9510Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC USA ,grid.253615.60000 0004 1936 9510Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC USA
| | - Rathinaswamy B. Govindan
- grid.239560.b0000 0004 0482 1586Children’s National Hospital, Prenatal Pediatrics Institute, Washington, DC USA ,grid.253615.60000 0004 1936 9510Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC USA
| | - Scott D. Barnett
- grid.239560.b0000 0004 0482 1586Children’s National Hospital, Prenatal Pediatrics Institute, Washington, DC USA
| | - Tareq Al-Shargabi
- grid.239560.b0000 0004 0482 1586Children’s National Hospital, Prenatal Pediatrics Institute, Washington, DC USA
| | - Daniel A. Reich
- grid.239560.b0000 0004 0482 1586Children’s National Hospital, Prenatal Pediatrics Institute, Washington, DC USA
| | - Sneha Iyer
- grid.253615.60000 0004 1936 9510The George Washington University School of Medicine and Health Sciences, Washington, DC USA
| | - Laura Hitchings
- grid.239560.b0000 0004 0482 1586Children’s National Hospital, Prenatal Pediatrics Institute, Washington, DC USA
| | | | - Robin Baker
- Inova Women’s and Children’s Hospital, Fairfax, VA USA ,grid.430970.9Fairfax Neonatal Associates, Fairfax, VA USA
| | - Adre J. du Plessis
- grid.239560.b0000 0004 0482 1586Children’s National Hospital, Prenatal Pediatrics Institute, Washington, DC USA ,grid.253615.60000 0004 1936 9510Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC USA ,grid.253615.60000 0004 1936 9510Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC USA
| | - Sarah B. Mulkey
- grid.239560.b0000 0004 0482 1586Children’s National Hospital, Prenatal Pediatrics Institute, Washington, DC USA ,grid.253615.60000 0004 1936 9510Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC USA ,grid.253615.60000 0004 1936 9510Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC USA
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Schlatterer SD, du Plessis AJ. Exposures influencing the developing central autonomic nervous system. Birth Defects Res 2020; 113:845-863. [PMID: 33270364 DOI: 10.1002/bdr2.1847] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/04/2020] [Accepted: 11/19/2020] [Indexed: 12/20/2022]
Abstract
Autonomic nervous system function is critical for transition from in-utero to ex-utero life and is associated with neurodevelopmental and neuropsychiatric outcomes later in life. Adverse prenatal and neonatal conditions and exposures can impair or alter ANS development and, as a result, may also impact long-term neurodevelopmental outcomes. The objective of this article is to provide a broad overview of the impact of factors that are known to influence autonomic development during the fetal and early neonatal period, including maternal mood and stress during and after pregnancy, fetal growth restriction, congenital heart disease, toxic exposures, and preterm birth. We touch briefly on the typical development of the ANS, then delve into both in-utero and ex-utero maternal and fetal factors that may impact developmental trajectory of the ANS and, thus, have implications in transition and in long-term developmental outcomes. While many types of exposures and conditions have been shown to impact development of the autonomic nervous system, there is still much to be learned about the mechanisms underlying these influences. In the future, more advanced neuromonitoring tools will be required to better understand autonomic development and its influence on long-term neurodevelopmental and neuropsychological function, especially during the fetal period.
Collapse
Affiliation(s)
- Sarah D Schlatterer
- Children's National Hospital, Prenatal Pediatrics Institute, Washington, District of Columbia, USA.,George Washington University School of Health Sciences, Departments of Neurology and Pediatrics, Washington, District of Columbia, USA
| | - Adre J du Plessis
- Children's National Hospital, Prenatal Pediatrics Institute, Washington, District of Columbia, USA.,George Washington University School of Health Sciences, Departments of Neurology and Pediatrics, Washington, District of Columbia, USA
| |
Collapse
|
7
|
Li R, Ye X, Li G, Cao X, Zou Y, Yao S, Luo F, Zhang L, Dong W. Effects of Different Body Positions and Head Elevation Angles on Regional Cerebral Oxygen Saturation in Premature Infants of China. J Pediatr Nurs 2020; 55:1-5. [PMID: 32570090 DOI: 10.1016/j.pedn.2020.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND To investigate the effects of different body positions and head elevation angles on regional cerebral oxygen saturation in premature infants using near-infrared spectroscopy (NIRS). METHODS This was a prospective study of premature infants hospitalized. The position was changed each feeding cycle (2-3 h), in order: 15° prone, 15° supine, 0° prone, and 0° supine position. Regional cerebral oxygen saturation (rSO2) was measured after each position period using NIRS, over 7 days. FINDINGS Thirty-three premature infants were included in the analysis. Among them, 22 (66.7%) were male, and 11 (33.3%) were female. When placing the premature infants in the prone position, the regional cerebral oxygen saturation (rSO2) values were higher at head elevation 15° compared with 0° (main effect P < 0.001). When placing the premature infants in the supine position, rSO2 was higher at a head elevation of 15° compared with that at 0° (main effect P < 0.001). When placing the premature infants with a head elevation of 15°, rSO2 in the prone position was higher than that of the supine position (main effect P < 0.001). There was no difference between the prone and supine positions when placing the premature infants with the head elevation at 0° (P > 0.05). DISCUSSION Higher cerebral rSO2 can be achieved when placing premature infants in the prone or supine position, with a 15° head elevation angle. APPLICATION TO PRACTICE Using a specific body position and head angle could improve the regional cerebral oxygen saturation of premature infants.
Collapse
Affiliation(s)
- Run Li
- Department of Newborn Medicine, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Sichuan, China
| | - Xiaoxiu Ye
- Department of Newborn Medicine, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Sichuan, China
| | - Guiping Li
- Department of Newborn Medicine, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Sichuan, China
| | - Xiaokuan Cao
- Department of Newborn Medicine, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Sichuan, China
| | - Yuanxia Zou
- Department of Newborn Medicine, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Sichuan, China
| | - Shihan Yao
- Department of Newborn Medicine, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Sichuan, China
| | - Feng Luo
- Department of Newborn Medicine, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Sichuan, China
| | - Lin Zhang
- Department of Newborn Medicine, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Sichuan, China
| | - Wenbin Dong
- Department of Newborn Medicine, Affiliated Hospital of Southwest Medical University, Sichuan, China.
| |
Collapse
|
8
|
Chiera M, Cerritelli F, Casini A, Barsotti N, Boschiero D, Cavigioli F, Corti CG, Manzotti A. Heart Rate Variability in the Perinatal Period: A Critical and Conceptual Review. Front Neurosci 2020; 14:561186. [PMID: 33071738 PMCID: PMC7544983 DOI: 10.3389/fnins.2020.561186] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/28/2020] [Indexed: 12/18/2022] Open
Abstract
Neonatal intensive care units (NICUs) greatly expand the use of technology. There is a need to accurately diagnose discomfort, pain, and complications, such as sepsis, mainly before they occur. While specific treatments are possible, they are often time-consuming, invasive, or painful, with detrimental effects for the development of the infant. In the last 40 years, heart rate variability (HRV) has emerged as a non-invasive measurement to monitor newborns and infants, but it still is underused. Hence, the present paper aims to review the utility of HRV in neonatology and the instruments available to assess it, showing how HRV could be an innovative tool in the years to come. When continuously monitored, HRV could help assess the baby’s overall wellbeing and neurological development to detect stress-/pain-related behaviors or pathological conditions, such as respiratory distress syndrome and hyperbilirubinemia, to address when to perform procedures to reduce the baby’s stress/pain and interventions, such as therapeutic hypothermia, and to avoid severe complications, such as sepsis and necrotizing enterocolitis, thus reducing mortality. Based on literature and previous experiences, the first step to efficiently introduce HRV in the NICUs could consist in a monitoring system that uses photoplethysmography, which is low-cost and non-invasive, and displays one or a few metrics with good clinical utility. However, to fully harness HRV clinical potential and to greatly improve neonatal care, the monitoring systems will have to rely on modern bioinformatics (machine learning and artificial intelligence algorithms), which could easily integrate infant’s HRV metrics, vital signs, and especially past history, thus elaborating models capable to efficiently monitor and predict the infant’s clinical conditions. For this reason, hospitals and institutions will have to establish tight collaborations between the obstetric, neonatal, and pediatric departments: this way, healthcare would truly improve in every stage of the perinatal period (from conception to the first years of life), since information about patients’ health would flow freely among different professionals, and high-quality research could be performed integrating the data recorded in those departments.
Collapse
Affiliation(s)
- Marco Chiera
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy.,Research Commission on Manual Therapies and Mind-Body Disciplines, Societ Italiana di Psico Neuro Endocrino Immunologia, Rome, Italy
| | - Francesco Cerritelli
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Alessandro Casini
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Nicola Barsotti
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy.,Research Commission on Manual Therapies and Mind-Body Disciplines, Societ Italiana di Psico Neuro Endocrino Immunologia, Rome, Italy
| | | | - Francesco Cavigioli
- Neonatal Intensive Care Unit, "V. Buzzi" Children's Hospital, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Milan, Italy
| | - Carla G Corti
- Pediatric Cardiology Unit-Pediatric Department, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Milan, Italy
| | - Andrea Manzotti
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy.,Neonatal Intensive Care Unit, "V. Buzzi" Children's Hospital, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Milan, Italy.,Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| |
Collapse
|
9
|
Singh J, Lanzarini E, Santosh P. Organic features of autonomic dysregulation in paediatric brain injury - Clinical and research implications for the management of patients with Rett syndrome. Neurosci Biobehav Rev 2020; 118:809-827. [PMID: 32861739 DOI: 10.1016/j.neubiorev.2020.08.012] [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: 03/16/2020] [Revised: 08/11/2020] [Accepted: 08/15/2020] [Indexed: 12/18/2022]
Abstract
Rett Syndrome (RTT) is a complex neurodevelopmental disorder with autonomic nervous system dysfunction. The understanding of this autonomic dysregulation remains incomplete and treatment recommendations are lacking. By searching literature regarding childhood brain injury, we wanted to see whether understanding autonomic dysregulation following childhood brain injury as a prototype can help us better understand the autonomic dysregulation in RTT. Thirty-one (31) articles were identified and following thematic analysis the three main themes that emerged were (A) Recognition of Autonomic Dysregulation, (B) Possible Mechanisms & Assessment of Autonomic Dysregulation and (C) Treatment of Autonomic Dysregulation. We conclude that in patients with RTT (I) anatomically, thalamic and hypothalamic function should be explored, (II) sensory issues and medication induced side effects that can worsen autonomic function should be considered, and (III) diaphoresis and dystonia ought to be better managed. Our synthesis of data from autonomic dysregulation in paediatric brain injury has led to increased knowledge and a better understanding of its underpinnings, leading to the development of application protocols in children with RTT.
Collapse
Affiliation(s)
- Jatinder Singh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK; Centre for Personalised Medicine in Rett Syndrome, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Evamaria Lanzarini
- Child and Adolescent Neuropsychiatry Unit, Infermi Hospital, Rimini, Italy
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK; Centre for Personalised Medicine in Rett Syndrome, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| |
Collapse
|
10
|
Mitra S, Bale G, Meek J, Tachtsidis I, Robertson NJ. Cerebral Near Infrared Spectroscopy Monitoring in Term Infants With Hypoxic Ischemic Encephalopathy-A Systematic Review. Front Neurol 2020; 11:393. [PMID: 32536901 PMCID: PMC7267214 DOI: 10.3389/fneur.2020.00393] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/17/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Neonatal hypoxic ischemic encephalopathy (HIE) remains a significant cause of mortality and morbidity worldwide. Cerebral near infrared spectroscopy (NIRS) can provide cot side continuous information about changes in brain hemodynamics, oxygenation and metabolism in real time. Objective: To perform a systematic review of cerebral NIRS monitoring in term and near-term infants with HIE. Search Methods: A systematic search was performed in Ovid EMBASE and Medline database from inception to November 2019. The search combined three broad categories: measurement (NIRS monitoring), disease condition [hypoxic ischemic encephalopathy (HIE)] and subject category (newborn infants) using a stepwise approach as per PRISMA guidance. Selection Criteria: Only human studies published in English were included. Data Collection and Analysis: Two authors independently selected, assessed the quality, and extracted data from the studies for this review. Results: Forty-seven studies on term and near-term infants following HIE were identified. Most studies measured multi-distance NIRS based cerebral tissue saturation using monitors that are referred to as cerebral oximeters. Thirty-nine studies were published since 2010; eight studies were published before this. Fifteen studies reviewed the neurodevelopmental outcome in relation to NIRS findings. No randomized study was identified. Conclusion: Commercial NIRS cerebral oximeters can provide important information regarding changes in cerebral oxygenation and hemodynamics following HIE and can be particularly helpful when used in combination with other neuromonitoring tools. Optical measurements of brain metabolism using broadband NIRS and cerebral blood flow using diffuse correlation spectroscopy add additional pathophysiological information. Further randomized clinical trials and large observational studies are necessary with proper study design to assess the utility of NIRS in predicting neurodevelopmental outcome and guiding therapeutic interventions.
Collapse
Affiliation(s)
- Subhabrata Mitra
- Neonatology, Institute for Women's Health, University College London, London, United Kingdom
| | - Gemma Bale
- Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Judith Meek
- Neonatology, Institute for Women's Health, University College London, London, United Kingdom
| | - Ilias Tachtsidis
- Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Nicola J. Robertson
- Neonatology, Institute for Women's Health, University College London, London, United Kingdom
| |
Collapse
|
11
|
Popescu MR, Panaitescu AM, Pavel B, Zagrean L, Peltecu G, Zagrean AM. Getting an Early Start in Understanding Perinatal Asphyxia Impact on the Cardiovascular System. Front Pediatr 2020; 8:68. [PMID: 32175294 PMCID: PMC7055155 DOI: 10.3389/fped.2020.00068] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/12/2020] [Indexed: 12/12/2022] Open
Abstract
Perinatal asphyxia (PA) is a burdening pathology with high short-term mortality and severe long-term consequences. Its incidence, reaching as high as 10 cases per 1000 live births in the less developed countries, prompts the need for better awareness and prevention of cases at risk, together with management by easily applicable protocols. PA acts first and foremost on the nervous tissue, but also on the heart, by hypoxia and subsequent ischemia-reperfusion injury. Myocardial development at birth is still incomplete and cannot adequately respond to this aggression. Cardiac dysfunction, including low ventricular output, bradycardia, and pulmonary hypertension, complicates the already compromised circulatory status of the newborn with PA. Multiorgan and especially cardiovascular failure seem to play a crucial role in the secondary phase of hypoxic-ischemic encephalopathy (HIE) and its high mortality rate. Hypothermia is an acceptable solution for HIE, but there is a fragile equilibrium between therapeutic gain and cardiovascular instability. A profound understanding of the underlying mechanisms of the nervous and cardiovascular systems and a close collaboration between the bench and bedside specialists in these domains is compulsory. More resources need to be directed toward the prevention of PA and the consecutive decrease of cardiovascular dysfunction. Not much can be done in case of an unexpected acute event that produces PA, where recognition and prompt delivery are the key factors for a positive clinical result. However, the situation is different for high-risk pregnancies or circumstances that make the fetus more vulnerable to asphyxia. Improving the outcome in these cases is possible through careful monitoring, identifying the high-risk pregnancies, and the implementation of novel prenatal strategies. Also, apart from adequately supporting the heart through the acute episode, there is a need for protocols for long-term cardiovascular follow-up. This will increase our recognition of any lasting myocardial damage and will enhance our perspective on the real impact of PA. The goal of this article is to review data on the cardiovascular consequences of PA, in the context of an immature cardiovascular system, discuss the potential contribution of cardiovascular impairment on short and long-term outcomes, and propose further directions of research in this field.
Collapse
Affiliation(s)
- Mihaela Roxana Popescu
- Cardiology Department, Elias University Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Anca Maria Panaitescu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Bogdan Pavel
- Division of Physiology and Neuroscience, Department of Functional Sciences, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Intensive Care Department, Clinical Emergency Hospital of Plastic Surgery and Burns, Bucharest, Romania
| | - Leon Zagrean
- Division of Physiology and Neuroscience, Department of Functional Sciences, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Gheorghe Peltecu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Ana-Maria Zagrean
- Division of Physiology and Neuroscience, Department of Functional Sciences, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| |
Collapse
|
12
|
Bojić T. Editorial: Neurocardiovascular Diseases: New Aspects of the Old Issues. Front Neurosci 2019; 12:1032. [PMID: 30686991 PMCID: PMC6336917 DOI: 10.3389/fnins.2018.01032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/20/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Tijana Bojić
- Laboratory of Radiobiology and Molecular Genetics, Institute of Nuclear Sciences Vinča, University of Belgrade, Belgrade, Serbia
| |
Collapse
|