1
|
Pavel A, Mathieson SR, Livingstone V, O’Toole JM, Pressler RM, de Vries LS, Rennie JM, Mitra S, Dempsey EM, Murray DM, Marnane WP, Boylan GB. Heart rate variability analysis for the prediction of EEG grade in infants with hypoxic ischaemic encephalopathy within the first 12 h of birth. Front Pediatr 2023; 10:1016211. [PMID: 36683815 PMCID: PMC9845713 DOI: 10.3389/fped.2022.1016211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/16/2022] [Indexed: 01/06/2023] Open
Abstract
Background and aims Heart rate variability (HRV) has previously been assessed as a biomarker for brain injury and prognosis in neonates. The aim of this cohort study was to use HRV to predict the electroencephalography (EEG) grade in neonatal hypoxic-ischaemic encephalopathy (HIE) within the first 12 h. Methods We included 120 infants with HIE recruited as part of two European multi-centre studies, with electrocardiography (ECG) and EEG monitoring performed before 12 h of age. HRV features and EEG background were assessed using the earliest 1 h epoch of ECG-EEG monitoring. HRV was expressed in time, frequency and complexity features. EEG background was graded from 0-normal, 1-mild, 2-moderate, 3-major abnormalities to 4-inactive. Clinical parameters known within 6 h of birth were collected (intrapartum complications, foetal distress, gestational age, mode of delivery, gender, birth weight, Apgar at 1 and 5, assisted ventilation at 10 min). Using logistic regression analysis, prediction models for EEG severity were developed for HRV features and clinical parameters, separately and combined. Multivariable model analysis included 101 infants without missing data. Results Of 120 infants included, 54 (45%) had normal-mild and 66 (55%) had moderate-severe EEG grade. The performance of HRV model was AUROC 0.837 (95% CI: 0.759-0.914) and clinical model was AUROC 0.836 (95% CI: 0.759-0.914). The HRV and clinical model combined had an AUROC of 0.895 (95% CI: 0.832-0.958). Therapeutic hypothermia and anti-seizure medication did not affect the model performance. Conclusions Early HRV and clinical information accurately predicted EEG grade in HIE within the first 12 h of birth. This might be beneficial when EEG monitoring is not available in the early postnatal period and for referral centres who may want some objective information on HIE severity.
Collapse
Affiliation(s)
- Andreea M Pavel
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Sean R Mathieson
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Vicki Livingstone
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - John M O’Toole
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Ronit M Pressler
- Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Linda S de Vries
- Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Janet M Rennie
- Institute for Women's Health, University College London, London, United Kingdom
| | - Subhabrata Mitra
- Institute for Women's Health, University College London, London, United Kingdom
| | - Eugene M Dempsey
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Deirdre M Murray
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - William P Marnane
- INFANT Research Centre, University College Cork, Cork, Ireland
- School of Engineering, University College Cork, Cork, Ireland
| | - Geraldine B Boylan
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | | |
Collapse
|
2
|
Chock VY, Rao A, Van Meurs KP. Optimal neuromonitoring techniques in neonates with hypoxic ischemic encephalopathy. Front Pediatr 2023; 11:1138062. [PMID: 36969281 PMCID: PMC10030520 DOI: 10.3389/fped.2023.1138062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/20/2023] [Indexed: 03/29/2023] Open
Abstract
Neonates with hypoxic ischemic encephalopathy (HIE) are at significant risk for adverse outcomes including death and neurodevelopmental impairment. Neuromonitoring provides critical diagnostic and prognostic information for these infants. Modalities providing continuous monitoring include continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), near-infrared spectroscopy (NIRS), and heart rate variability. Serial bedside neuromonitoring techniques include cranial ultrasound and somatic and visual evoked potentials but may be limited by discrete time points of assessment. EEG, aEEG, and NIRS provide distinct and complementary information about cerebral function and oxygen utilization. Integrated use of these neuromonitoring modalities in addition to other potential techniques such as heart rate variability may best predict imaging outcomes and longer-term neurodevelopment. This review examines available bedside neuromonitoring techniques for the neonate with HIE in the context of therapeutic hypothermia.
Collapse
|
3
|
Improving child health through Big Data and data science. Pediatr Res 2023; 93:342-349. [PMID: 35974162 PMCID: PMC9380977 DOI: 10.1038/s41390-022-02264-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/10/2022] [Accepted: 06/28/2022] [Indexed: 12/04/2022]
Abstract
Child health is defined by a complex, dynamic network of genetic, cultural, nutritional, infectious, and environmental determinants at distinct, developmentally determined epochs from preconception to adolescence. This network shapes the future of children, susceptibilities to adult diseases, and individual child health outcomes. Evolution selects characteristics during fetal life, infancy, childhood, and adolescence that adapt to predictable and unpredictable exposures/stresses by creating alternative developmental phenotype trajectories. While child health has improved in the United States and globally over the past 30 years, continued improvement requires access to data that fully represent the complexity of these interactions and to new analytic methods. Big Data and innovative data science methods provide tools to integrate multiple data dimensions for description of best clinical, predictive, and preventive practices, for reducing racial disparities in child health outcomes, for inclusion of patient and family input in medical assessments, and for defining individual disease risk, mechanisms, and therapies. However, leveraging these resources will require new strategies that intentionally address institutional, ethical, regulatory, cultural, technical, and systemic barriers as well as developing partnerships with children and families from diverse backgrounds that acknowledge historical sources of mistrust. We highlight existing pediatric Big Data initiatives and identify areas of future research. IMPACT: Big Data and data science can improve child health. This review highlights the importance for child health of child-specific and life course-based Big Data and data science strategies. This review provides recommendations for future pediatric-specific Big Data and data science research.
Collapse
|
4
|
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
|
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
|
Statello R, Carnevali L, Sgoifo A, Miragoli M, Pisani F. Heart rate variability in neonatal seizures: Investigation and implications for management. Neurophysiol Clin 2021; 51:483-492. [PMID: 34774410 DOI: 10.1016/j.neucli.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 02/07/2023] Open
Abstract
Many factors acting during the neonatal period can affect neurological development of the infant. Neonatal seizures (NS) that frequently occur in the immature brain may influence autonomic maturation and lead to detectable cardiovascular signs. These autonomic manifestations can also have significant diagnostic and prognostic value. The analysis of Heart Rate Variability (HRV) represents the most used and feasible method to evaluate cardiac autonomic regulation. This narrative review summarizes studies investigating HRV dynamics in newborns with seizures, with the aim of highlighting the potential utility of HRV measures for seizure detection and management. While HRV analysis in critically ill newborns is influenced by many potential confounders, we suggest that it can enhance the ability to better diagnose seizures in the clinical setting. We present potential applications of the analysis of HRV, which could have a useful future role, beyond the research setting.
Collapse
Affiliation(s)
- Rosario Statello
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Luca Carnevali
- Stress Physiology Lab, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Andrea Sgoifo
- Stress Physiology Lab, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Michele Miragoli
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Departement of Molecular Cardiology, Humanitas Research Hospital, IRCCS, Rozzano MI, Italy.
| | - Francesco Pisani
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
| |
Collapse
|
7
|
Correlation Between Heart Rate Characteristic Index Score and Severity of Brain Injury in Neonates With Hypoxic-Ischemic Encephalopathy. Adv Neonatal Care 2020; 20:E70-E82. [PMID: 31895138 DOI: 10.1097/anc.0000000000000686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hypoxic-ischemic encephalopathy (HIE) remains devastating for neonates despite widespread treatment with therapeutic hypothermia (TH). The heart rate characteristic (HRC) index score, a measure of heart rate variability, could prove useful in the management of neonates with HIE as new therapies emerge or when withdrawal-of-support decisions are being considered. PURPOSE The main purpose was to describe correlation between HRC index scores and brain magnetic resonance imaging (MRI) severity of injury for neonates with HIE. METHODS/ANALYSIS Low/high HRC index scores retrieved at initiation of TH (baseline), 24, 48, 72, and 96 hours, brain MRI severity of injury, and National Institute of Child Health and Human Development Death/Disability and Death scores were collected and analyzed retrospectively. Independent t tests and linear regression were used to examine relationships for each outcome measure. RESULTS Twenty-seven neonates were stratified into 2 groups: noninjury (n = 11) and injury (n = 16). Statistically significant relationships were observed. Strikingly, mean low HRC index score for the noninjury group ranged between 0.37 and 0.65 and was between 0.61 and 0.86 for the injury group. Mean high HRC index score for the noninjury group ranged between 0.66 and 1.02 and was between 1.04 and 1.41 for the injury group. IMPLICATIONS FOR PRACTICE HRC index score may be a useful guide in the future management of neonates with HIE. IMPLICATIONS FOR RESEARCH This study established correlations between HRC index and MRI injury scores in neonates treated with TH. Further research is warranted to establish important relationships between brain injury and HRC index scores before this tool can be used clinically for this purpose.
Collapse
|
8
|
Lundell RV, Räisänen-Sokolowski AK, Wuorimaa TK, Ojanen T, Parkkola KI. Diving in the Arctic: Cold Water Immersion's Effects on Heart Rate Variability in Navy Divers. Front Physiol 2020; 10:1600. [PMID: 32082177 PMCID: PMC7005786 DOI: 10.3389/fphys.2019.01600] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 12/20/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction Diving close to the Arctic circle means diving in cold water regardless of the time of year. The human body reacts to cold through autonomous nervous system (ANS)-mediated thermoregulatory mechanisms. Diving also induces ANS responses as a result of the diving reflex. Materials and Methods In order to study ANS responses during diving in Arctic water temperatures, we retrospectively analyzed repeated 5-min heart rate variability (HRV) measures and the mean body temperature from dives at regular intervals using naval diving equipment measurement tests in 0°C water. Three divers performed seven dives without physical activity (81–91 min), and two divers performed four dives with physical activity after 10 min of diving (0–10 min HRV recordings were included in the study). Results Our study showed a significant increase in parasympathetic activity (PNS) at the beginning of the dives, after which PNS activity decreased significantly (measure 5–10 min). Subsequent measurements (15–20 min and onward) showed a significant increase in PNS activity over time. Conclusion Our results suggest that the first PNS responses of the human diving reflex decrease quickly. Adverse effects of PNS activity should be considered on long and cold dives. To avoid concurrent sympathetic (SNS) and PNS activity at the beginning of dives, which in turn may increase the risk of arrhythmia in cold water, we suggest a short adaptation phase before physical activity. Moreover, we suggest it is prudent to give special attention to cardiovascular risk factors during pre-dive examinations for cold water divers.
Collapse
Affiliation(s)
- Richard V Lundell
- Diving Medical Centre, Centre for Military Medicine, The Finnish Defence Forces, Helsinki, Finland.,Doctoral Programme in Clinical Research, University of Helsinki, Helsinki, Finland
| | - Anne K Räisänen-Sokolowski
- Department of Pathology, HUSLAB, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Centre for Military Medicine, The Finnish Defence Forces, Kirkkonummi, Finland
| | - Tomi K Wuorimaa
- Diving Medical Centre, Centre for Military Medicine, The Finnish Defence Forces, Kirkkonummi, Finland
| | - Tommi Ojanen
- Human Performance Division, Finnish Defence Research Agency, The Finnish Defence Forces, Tuusula, Finland
| | - Kai I Parkkola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,National Defence University, Helsinki, Finland
| |
Collapse
|
9
|
Endoh H, Kamimura N, Honda H, Nitta M. Early prognostication of neurological outcome by heart rate variability in adult patients with out-of-hospital sudden cardiac arrest. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:323. [PMID: 31623658 PMCID: PMC6798365 DOI: 10.1186/s13054-019-2603-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 09/06/2019] [Indexed: 01/20/2023]
Abstract
Background Most deaths of comatose survivors of out-of-hospital sudden cardiac arrest result from withdrawal of life-sustaining treatment (WLST) decisions based on poor neurological prognostication and the family’s intention. Thus, accurate prognostication is crucial to avoid premature WLST decisions. However, targeted temperature management (TTM) with sedation or neuromuscular blockade against shivering significantly affects early prognostication. In this study, we investigated whether heart rate variability (HRV) analysis could prognosticate poor neurological outcome in comatose patients undergoing hypothermic TTM. Methods Between January 2015 and December 2017, adult patients with out-of-hospital sudden cardiac arrest, successfully resuscitated in the emergency department and admitted to the intensive care unit of the Niigata University in Japan, were prospectively included. All patients had an initial Glasgow Coma Scale motor score of 1 and received hypothermic TTM (at 34 °C). Twenty HRV-related variables (deceleration capacity; 4 time-, 3 geometric-, and 7 frequency-domain; and 5 complexity variables) were computed based on RR intervals between 0:00 and 8:00 am within 24 h after return of spontaneous circulation (ROSC). Based on Glasgow Outcome Scale (GOS) at 2 weeks after ROSC, patients were divided into good outcome (GOS 1–2) and poor outcome (GOS 3–5) groups. Results Seventy-six patients were recruited and allocated to the good (n = 22) or poor (n = 54) outcome groups. Of the 20 HRV-related variables, ln very-low frequency (ln VLF) power, detrended fluctuation analysis (DFA) (α1), and multiscale entropy (MSE) index significantly differed between the groups (p = 0.001), with a statistically significant odds ratio (OR) by univariate logistic regression analysis (p = 0.001). Multivariate logistic regression analysis of the 3 variables identified ln VLF power and DFA (α1) as significant predictors for poor outcome (OR = 0.436, p = 0.006 and OR = 0.709, p = 0.024, respectively). The area under the receiver operating characteristic curve for ln VLF power and DFA (α1) in predicting poor outcome was 0.84 and 0.82, respectively. In addition, the minimum value of ln VLF power or DFA (α1) for the good outcome group predicted poor outcome with sensitivity = 61% and specificity = 100%. Conclusions The present data indicate that HRV analysis could be useful for prognostication for comatose patients during hypothermic TTM.
Collapse
Affiliation(s)
- Hiroshi Endoh
- Department of Emergency & Critical Care Medicine, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8520, Japan. .,Advanced Emergency and Critical Care Center, Niigata University Medical & Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata, 951-8520, Japan.
| | - Natuo Kamimura
- Department of Emergency & Critical Care Medicine, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8520, Japan.,Advanced Emergency and Critical Care Center, Niigata University Medical & Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata, 951-8520, Japan
| | - Hiroyuki Honda
- Advanced Emergency and Critical Care Center, Niigata University Medical & Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata, 951-8520, Japan
| | - Masakazu Nitta
- Advanced Emergency and Critical Care Center, Niigata University Medical & Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata, 951-8520, Japan
| |
Collapse
|
10
|
Yasova Barbeau D, Krueger C, Huene M, Copenhaver N, Bennett J, Weaver M, Weiss MD. Heart rate variability and inflammatory markers in neonates with hypoxic-ischemic encephalopathy. Physiol Rep 2019; 7:e14110. [PMID: 31397094 PMCID: PMC6687857 DOI: 10.14814/phy2.14110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 12/19/2022] Open
Abstract
To examine heart rate variability (HRV) and inflammatory markers as predictors for neurological injury in neonates undergoing therapeutic hypothermia for hypoxic-ischemic encephalopathy (HIE). We hypothesized that HRV would differentiate between infants with no/mild injury and infants with moderate/severe injury observed on MRI. Because HRV can be associated with the inflammatory cascade, cytokine concentrations were compared with the severity of brain injury indicated by MRI. Further, we studied the effect of temperature, sex, and mechanical ventilation on HRV. HRV was prospectively collected on neonates with HIE using spectral analysis for low and high frequency components (n = 16). A subset (n = 10) of neonates had serum available for inflammatory cytokine analysis obtained during cooling. Neonates were stratified into no/mild or moderate/severe injury based on MRI obtained after rewarming. Differences in HRV were identified; lower low frequency power predicted more injury on MRI. Additionally, in neonates with HIE after cooling procedure, HRV differed by gender. Elevated RANTES (CCL5) and decreased GM-CSF (Granulocyte-macrophage colony-stimulating factor) at 96 hours predicted less severe injury. In this small study, HRV differs between no/mild and moderate/severe injury in neonates with HIE. With further study, this may aid the clinician in real-time decision making. HRV differs by gender. Finally, inflammatory biomarkers may help elucidate the pathophysiology of HIE.
Collapse
Affiliation(s)
| | | | - Melissa Huene
- Department of PediatricsUniversity of FloridaGainesvilleFlorida
| | | | | | - Michael Weaver
- Department of StatisticsUniversity of FloridaGainesvilleFlorida
- Department of BiostatisticsUniversity of FloridaGainesvilleFlorida
| | | |
Collapse
|
11
|
Andersen M, Andelius TCK, Pedersen MV, Kyng KJ, Henriksen TB. Severity of hypoxic ischemic encephalopathy and heart rate variability in neonates: a systematic review. BMC Pediatr 2019; 19:242. [PMID: 31324176 PMCID: PMC6639904 DOI: 10.1186/s12887-019-1603-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several studies have investigated heart rate variability (HRV) as a biomarker for acute brain injury in hypoxic ischemic encephalopathy (HIE). However, the current evidence is heterogeneous and needs further reviewing to direct future studies. We aimed to systematically review whether HIE severity is associated with HRV. METHODS This systematic review was conducted according to the preferred reporting items for systematic review and meta analyses (PRISMA). We included studies comparing neonates with severe or moderate HIE with neonates with mild or no HIE with respect to different HRV measures within 7 days of birth. Article selection and quality assessment was independently performed by two reviewers. Risk of bias and strength of evidence was evaluated by the Newcastle-Ottawa scale (NOS) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS We screened 1187 studies. From these, four observational studies with 248 neonates were included. For all HRV measures, the strength of evidence was very low. Neonates with severe or moderate HIE showed a reduction in most HRV measures compared to neonates with mild or no HIE with a greater reduction in those with severe HIE. CONCLUSIONS Moderate and severe HIE was associated with a reduction in most HRV measures. Accordingly, HRV is a potential biomarker for HIE severity during the first week of life. However, the uncertainty calls for more studies.
Collapse
Affiliation(s)
- Mads Andersen
- Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.
| | - Ted C K Andelius
- Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Mette V Pedersen
- Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Kasper J Kyng
- Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Tine B Henriksen
- Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| |
Collapse
|
12
|
Oliveira V, Martins R, Liow N, Teiserskas J, von Rosenberg W, Adjei T, Shivamurthappa V, Lally PJ, Mandic D, Thayyil S. Prognostic Accuracy of Heart Rate Variability Analysis in Neonatal Encephalopathy: A Systematic Review. Neonatology 2019; 115:59-67. [PMID: 30300885 DOI: 10.1159/000493002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/17/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Heart rate variability analysis offers real-time quantification of autonomic disturbance after perinatal asphyxia, and may therefore aid in disease stratification and prognostication after neonatal encephalopathy (NE). OBJECTIVE To systematically review the existing literature on the accuracy of early heart rate variability (HRV) to predict brain injury and adverse neurodevelopmental outcomes after NE. DESIGN/METHODS We systematically searched the literature published between May 1947 and May 2018. We included all prospective and retrospective studies reporting HRV metrics, within the first 7 days of life in babies with NE, and its association with adverse outcomes (defined as evidence of brain injury on magnetic resonance imaging and/or abnormal neurodevelopment at ≥1 year of age). We extracted raw data wherever possible to calculate the prognostic indices with confidence intervals. RESULTS We retrieved 379 citations, 5 of which met the criteria. One further study was excluded as it analysed an already-included cohort. The 4 studies provided data on 205 babies, 80 (39%) of whom had adverse outcomes. Prognostic accuracy was reported for 12 different HRV metrics and the area under the curve (AUC) varied between 0.79 and 0.94. The best performing metric reported in the included studies was the relative power of high-frequency band, with an AUC of 0.94. CONCLUSIONS HRV metrics are a promising bedside tool for early prediction of brain injury and neurodevelopmental outcome in babies with NE. Due to the small number of studies available, their heterogeneity and methodological limitations, further research is needed to refine this tool so that it can be used in clinical practice.
Collapse
Affiliation(s)
- Vânia Oliveira
- Centre for Perinatal Neuroscience, Imperial College London, London, United
| | - Rui Martins
- Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Natasha Liow
- Neonatal Unit, Imperial Healthcare NHS Trust, London, United Kingdom
| | | | - Wilhelm von Rosenberg
- Electrical and Electronic Engineering, Imperial College London, London, United Kingdom
| | - Tricia Adjei
- Electrical and Electronic Engineering, Imperial College London, London, United Kingdom
| | | | - Peter J Lally
- Centre for Perinatal Neuroscience, Imperial College London, London, United Kingdom
| | - Danilo Mandic
- Electrical and Electronic Engineering, Imperial College London, London, United Kingdom
| | - Sudhin Thayyil
- Centre for Perinatal Neuroscience, Imperial College London, London, United Kingdom
| |
Collapse
|
13
|
Hodges GJ, Ferguson SAH, Cheung SS. Cardiac autonomic function during hypothermia and its measurement repeatability. Appl Physiol Nutr Metab 2018; 44:31-36. [PMID: 29944845 DOI: 10.1139/apnm-2018-0248] [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] [Indexed: 12/11/2022]
Abstract
This study examined the effect of mild hypothermia (a 0.5 °C decrease in rectal temperature) on heart rate variability (HRV), with the identical hypothermia protocol performed twice and compared using intraclass correlation coefficient (r) analysis to study the repeatability. Twelve healthy males each completed 1 neutral (23 °C) and 2 cold (0 °C) trials. In the neutral trial, participants sat quietly for 30 min. In the cold trials, baseline data were obtained from a 5-min sample following 30 min of quiet sitting at 23 °C, followed by passive exposure to 0 °C; hypothermic measures were taken from a 5-min period immediately prior to rectal temperature decreasing by 0.5 °C. HRV was obtained from a 3-lead electrocardiogram. There were no differences (all p > 0.05) in baseline measures between the neutral and the 2 cold trials, suggesting no precooling anxiety related to the cold trials. Heart rate, together with HRV measures (i.e., root mean square difference of successive normal RR intervals, triangular interpolation of NN interval histogram, low-frequency oscillations (LF), and high-frequency oscillations (HF)), increased (all p < 0.05) with mild hypothermia and showed excellent reliability between the 2 cold trials (all r ≥ 0.81). In contrast, the LF/HF ratio decreased (p < 0.05) and had only fair reliability between the 2 cold trials (r = 0.551). In general, hypothermia led to increases in heart rate, together with most measures of HRV. Although it was counterintuitive that both sympathetic and vagal influences would increase simultaneously, these changes likely reflected increased stress from whole-body cooling, together with marked cardiovascular strain and sympathetic nervous system activity from shivering to defend core body temperature. An important methodological consideration for future studies is the consistent and repeatable HRV responses to hypothermia.
Collapse
Affiliation(s)
- Gary J Hodges
- Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada.,Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada
| | - Steven A H Ferguson
- Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada.,Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada
| | - Stephen S Cheung
- Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada.,Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada
| |
Collapse
|
14
|
Chalak L, Latremouille S, Mir I, Sánchez PJ, Sant'Anna G. A review of the conundrum of mild hypoxic-ischemic encephalopathy: Current challenges and moving forward. Early Hum Dev 2018; 120:88-94. [PMID: 29506900 DOI: 10.1016/j.earlhumdev.2018.02.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A review of the conundrum called mild hypoxic-ischemic encephalopathy (HIE) is provided. During the past decades, the definition of HIE has evolved to accommodate the short window of time required for the initiation of therapeutic hypothermia. Also, neurological evaluations have changed with the use of simpler staging systems that can be applied within the first 6 h of life. In this review, we discuss the challenges in the identification of newborns with "mild HIE" within 6 h after birth, the limitations in the existing early biomarkers of brain injury, and the current knowledge gaps in the long term neurodevelopmental outcomes of infants diagnosed with mild HIE. Progress in the understanding of mild HIE and its sequelae continues to be hindered by the lack of a standardized definition for mild HIE that will reliably identify at-risk infants who may benefit from neuroprotective strategies.
Collapse
Affiliation(s)
- Lina Chalak
- University of Texas Southwestern Medical Center, TX, Dallas, USA.
| | | | - Imran Mir
- University of Texas Southwestern Medical Center, TX, Dallas, USA
| | - Pablo J Sánchez
- Nationwide Children's Hospital - The Ohio State University College of Medicine, Columbus, OH, USA
| | | |
Collapse
|