Heart rate variability of preterm neonates quantified by energy entropy

The entropy of RR intervals is associated to gestational age in full-term newborns with adequate weight for gestational age

Introduction: The variability of successive RR intervals has been pointed out as an indicator of systemic homeostasis. The entropy of successive RR intervals is associated with a greater adaptive capacity, which is essential after childbirth, characterized by a change from an intrauterine environment that constantly adapts to the fetal demands, to an extrauterine environment that requires constant biological adaptations by the neonate.Objectives: To analyze the association between gestational age (GA) and the entropy of RR intervals in term infants with adequate birth weight in the first hours of extrauterine life.Methods: In a cross-sectional study design maternal, labor and neonatal characteristics were collected from the obstetric records. Successive RR intervals were recorded from neonates up to 72 hours (i.e. 3 days) of birth.Subjects: Fifty term infants, healthy and with adequate birth weight. Outcome measures: the variability of RR intervals was analyzed obtaining the entropy of 1000 successive RR intervals. Pearson's correlation was used to evaluate the association between GA and the entropy of successive RR intervals, while linear regression was used to obtain the coefficient of determination (r²) as well as a prediction model. The adequacy of the prediction model was evaluated using the Komolgorov-Smirnov test to evaluate the residuals distribution.Results: There was a positive and significant association between the studied variables (r = 0.437; p = .002). The coefficient of determination allowed us to infer that approximately 19.3% of the RR interval entropy from the studied sample can be explained by the GA (r² = 0.193; p = .002). The analysis of the residuals distribution confirmed that the regression model obtained here was adequate.Conclusion: Our results indicate that, even within a normal range of GA (≥37 a < 42 weeks) and birth weight, a longer intrauterine life allows a greater entropy of successive RR intervals, indicating a greater maturation of biological systems and adaptive capacity.