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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.
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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
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Christoffel K, De Asis-Cruz J, Govindan RB, Kim JH, Cook KM, Kapse K, Andescavage N, Basu S, Spoehr E, Limperopoulos C, du Plessis A. Central Autonomic Network and heart rate variability in premature neonates. Dev Neurosci 2024:000536513. [PMID: 38320522 PMCID: PMC11300706 DOI: 10.1159/000536513] [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: 06/13/2023] [Accepted: 01/18/2024] [Indexed: 02/08/2024] Open
Abstract
INTRODUCTION The Central Autonomic Network (CAN) is a hierarchy of brain structures that collectively influence cardiac autonomic input, mediating the majority of brain-heart interactions, but has never been studied in premature neonates. In this study, we use heart rate variability (HRV), which has been described as the "primary output" of the CAN, and resting state functional MRI to characterize brain-heart relationships in premature neonates. METHODS We studied premature neonates who underwent resting state functional MRI (rsfMRI) at term, (37-weeks postmenstrual age [PMA] or above) and had HRV data recorded during the same week of their MRI. HRV was derived from continuous electrocardiogram data during the week of the rsfMRI scan. For rsfMRI, a seed-based approach was used to define regions of interest (ROI) pertinent to the CAN, and blood oxygen level-dependent signal was correlated between each ROI as a measure of functional connectivity. HRV was correlated with CAN connectivity (CANconn) for each region, and sub-group analysis was performed based on sex and clinical comorbidities. RESULTS Forty-seven premature neonates were included in this study, with a mean gestational age at birth of 28.1 +/- 2.6 weeks. Term CANconn was found to be significantly correlated with HRV in approximately one-fifth of CAN connections. Two distinct patterns emerged among these HRV-CANconn relationships. In the first, increased HRV was associated with stronger CANconn of limbic regions. In the second pattern, stronger CANconn at the precuneus was associated with impaired HRV maturation. These patterns were especially pronounced in male premature neonates. CONCLUSION We report for the first time evidence of brain-heart relationships in premature neonates and an emerging CAN, most striking in male neonates, suggesting that the brain-heart axis may be more vulnerable in male premature neonates. Signatures in the heart rate may eventually become an important non-invasive tool to identify premature males at highest risk for neurodevelopmental impairment.
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Affiliation(s)
- Kelsey Christoffel
- Developing Brain Institute, Children’s National Hospital, Washington, DC
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC
| | | | | | - Jung Hoon Kim
- Developing Brain Institute, Children’s National Hospital, Washington, DC
| | - Kevin Michael Cook
- Developing Brain Institute, Children’s National Hospital, Washington, DC
| | - Kushal Kapse
- Developing Brain Institute, Children’s National Hospital, Washington, DC
| | | | - Sudeepta Basu
- Division of Neonatology, Children’s National Hospital, Washington, DC
| | - Emma Spoehr
- Developing Brain Institute, Children’s National Hospital, Washington, DC
| | | | - Adre du Plessis
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC
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Sanz JH, Cox S, Donofrio MT, Ishibashi N, McQuillen P, Peyvandi S, Schlatterer S. [Formula: see text] Trajectories of neurodevelopment and opportunities for intervention across the lifespan in congenital heart disease. Child Neuropsychol 2023; 29:1128-1154. [PMID: 36752083 PMCID: PMC10406974 DOI: 10.1080/09297049.2023.2173162] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/20/2023] [Indexed: 02/09/2023]
Abstract
Children with congenital heart disease (CHD) are at increased risk for neurodevelopmental challenges across the lifespan. These are associated with neurological changes and potential acquired brain injury, which occur across a developmental trajectory and which are influenced by an array of medical, sociodemographic, environmental, and personal factors. These alterations to brain development lead to an array of adverse neurodevelopmental outcomes, which impact a characteristic set of skills over the course of development. The current paper reviews existing knowledge of aberrant brain development and brain injury alongside associated neurodevelopmental challenges across the lifespan. These provide a framework for discussion of emerging and potential interventions to improve neurodevelopmental outcomes at each developmental stage.
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Affiliation(s)
- Jacqueline H Sanz
- Division of Neuropsychology, Children's National Hospital, Washington, D.C
- Departments of Psychiatry and Behavioral Sciences & Pediatrics at The George Washington University School of Medicine
| | - Stephany Cox
- Department of Pediatrics, Division of Developmental Medicine, Benioff Children's Hospital, University of California, San Francisco, CA
| | - Mary T Donofrio
- Division of Cardiology, Children's National Health System, Washington, D.C
- Department of Pediatrics at The George Washington University School of Medicine
| | - Nobuyuki Ishibashi
- Department of Pediatrics at The George Washington University School of Medicine
- Center for Neuroscience Research, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington D.C
| | - Patrick McQuillen
- Department of Pediatrics, Division of Developmental Medicine, Benioff Children's Hospital, University of California, San Francisco, CA
| | - Shabnam Peyvandi
- Department of Pediatrics, Division of Developmental Medicine, Benioff Children's Hospital, University of California, San Francisco, CA
| | - Sarah Schlatterer
- Department of Pediatrics at The George Washington University School of Medicine
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, D.C
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, D.C
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