Autonomic nervous system depression at term in neurologically normal premature infants

Mulkey, Sarah B.; Kota, Srinivas; Swisher, Christopher; Hitchings, Laura; Metzler, Marina; Wang, Yunfei; Maxwell, G. Larry; Baker, Robin; Plessis, Adré J. du; Govindan, Rathinaswamy B.

doi:10.1016/j.earlhumdev.2018.07.003

Cited by 38 publications

(39 citation statements)

References 33 publications

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“…While there are advances on the biological regulations, there is still a lack of established data on maturation of autonomic, particularly during the first months of life. It has been established that at least 37 weeks of in utero maturation are needed to achieve full autonomic maturation at birth [2, 27, 28, 29, 30]. As a matter of fact, both cardiac autonomic responsiveness and baroreflex loop are altered in preterm infants regardless of gestational age (GA) and remain very low at theoretical term when compared with full-term newborns [27, 28].…”

Section: Introductionmentioning

confidence: 99%

Autonomic maturation from birth to 2 years: normative values

Patural

Pichot²,

Flori³

et al. 2019

Heliyon

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Background While heart rate variability (HRV) constitutes a relevant non-invasive tool to assess the autonomic nervous system (ANS) function with recognized diagnostic or therapeutic implications, there is still a lack of established data on maturation of autonomic control of heart rate during the first months of life. The Autonomic Baby Evaluation ( AuBE ) cohort was built to establish, the normal autonomic maturation profile from birth up to 2 years, in a healthy population of full-term newborns. Methods Heart rate variability analysis was carried out in 271 full-term newborns (mean gestational age 39 wGA + 5 days) from reliable polysomnographic recordings at 0 (n = 270) and 6 (n = 221) months and from a 24-hour ambulatory electrocardiogram (ECG) at 12 (n = 210), 18 (n = 197), and 24 (n = 190) months. Indices of HRV analysis were calculated through the ANSLabTools software. Results Indices are dissociated according a temporal, geometrical, frequency, Poincaré, empirical mode decomposition, fractal, Chaos and DC/AC and entropy analysis. Each index is presented for five different periods of time, 0, 6, 12, 18 and 24 months and with smoothed values in the 3rd, 10th, 50th, 90th and 97th percentiles. Data are also presented for the full cohort and individualized by sex to account for gender variability. Discussion & conclusion The physiological autonomic maturation profile from birth to 2 years in a healthy population of term neonates results in a fine-tuning autonomic maturation underlying progressively a new equilibrium and privileging the parasympathetic activity over the sympathetic activity.

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Section: Introductionmentioning

confidence: 99%

Autonomic maturation from birth to 2 years: normative values

Patural

Pichot²,

Flori³

et al. 2019

Heliyon

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“…If this were the case, altered parasympathetic-related metrics during AS could reveal that the vagal system and the ANS still have to fully develop ( Yiallourou et al, 2012 ). An immature PNS may, thus, fail to balance the SNS and the hypothalamic–pituitary–adrenal axis activity under stressful conditions, thus increasing the risk of sepsis, necrotizing enterocolitis (NEC), or even SIDS ( Yiallourou et al, 2012 ; Stone et al, 2013 ; Sullivan et al, 2014 ; Mulkey et al, 2018 ).…”

Section: A Technological Analysis To Efficiently Monitor and Use Hrvmentioning

confidence: 99%

Heart Rate Variability in the Perinatal Period: A Critical and Conceptual Review

Chiera¹,

Cerritelli²,

Casini³

et al. 2020

Front. Neurosci.

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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 timeconsuming, 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 noninvasive 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-/painrelated 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.

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“…Anokhin, and R.M. Baevskii are recognized classics; no doubts exist with respect to the role of integrative systems, such as the endocrine and central and autonomic nervous system (ANS) and the importance of studying them [74,75,77].…”

Section: Paradox Of Analysis and Synthesis: Integrative Assessment Ofmentioning

confidence: 99%

Physical and Physiological Problems of Medical Monitoring

et al. 2020

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This review discusses physiological, engineering, ergonomic, cognitive, and economic aspects of medical monitoring, which is among the most rapidly developing and sophisticated areas of medicine and medical engineering in the current historical context. A particular emphasis is laid on clinical requirements for monitoring, monitors, and monitored parameters, as well as challenges and debatable and problematic aspects of monitoring, including interpretation of physiological signals, the impact of monitoring on treatment outcomes in patients, challenges in designing automated systems for controlling the physiological functions of a patient based on monitoring data, and monitoring of the integrative assessment of the state of the human body as a complementary and sometimes more effective alternative to conventional "analytical" types of monitoring of particular physiological functions and parameters.

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Autonomic nervous system depression at term in neurologically normal premature infants

Abstract: Autonomic maturation is impaired in a premature extrauterine environment. In the absence of destructive brain injury, our data suggest an important role for disturbed programming in this impaired autonomic development.

Cited by 38 publications

References 33 publications

Autonomic maturation from birth to 2 years: normative values

Autonomic maturation from birth to 2 years: normative values

Heart Rate Variability in the Perinatal Period: A Critical and Conceptual Review

Physical and Physiological Problems of Medical Monitoring

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