Heart Rate Variability in Extremely Preterm Infants Receiving Nasal CPAP and Non-Synchronized Noninvasive Ventilation Immediately After Extubation

Abstract

Nasal CPAP or ns-NIV provided immediately postextubation did not affect HRV. Interestingly, in an exploratory analysis, changes in HRV did occur during ns-NIV in the subgroup of infants who failed extubation. Hence, changes in HRV as early as 2 h after extubation should be further explored in larger studies as a potential predictor of postextubation respiratory failure.

The effects of nasal continuous positive airway pressure and high flow nasal cannula on heart rate variability in extremely preterm infants after extubation: A randomized crossover trial

“…For instance, a study in adults with chronic obstructive pulmonary disease showed that application of continuous distending pressure resulted in significant HRV changes, which was not found in healthy controls . Similarly, in neonates, previous work by our group revealed that extubation success and failure groups had different HRV responses prior to extubation or when randomly exposed to CPAP and NIPPV post‐extubation . For those reasons, our secondary analysis sought to investigate for subgroup differences based on the extubation outcome.…”

“…For instance, HRV has been demonstrated effective in the early identification of neonatal sepsis, prognostication of neonatal hypoxic‐ischemic encephalopathy, and prediction of extubation failure . More recently, our group also showed that infants exhibited different HRV responses when randomly exposed to NCPAP and ns‐NIPPV post‐extubation depending on their extubation outcome: success or failure . Thus, the primary objective of this study was to investigate the effects of HFNC and NCPAP during the first few hours post‐extubation on HRV in extremely preterm infants.…”

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

“…In infants, RMSSD correlated with several outcomes in both the short and the long term: ANS stage of development in the case of prematurity (Hoyer et al, 2009;Lucchini et al, 2016;Aye et al, 2018;Schneider et al, 2018), late-onset sepsis (Joshi et al, 2020), extubation success (Latremouille et al, 2018), recovering after admission in intensive care units (Marsillio et al, 2019), pain behavior (Weissman et al, 2012), short-term neurological development when measured during low blood pressure episodes (Semenova et al, 2018), and later neurological development at 2 years (Dimitrijević et al, 2016). RMSSD showed also to change according to the incubator temperature, thus revealing how infant's HRV changes due to environmental temperature (Stéphan-Blanchard et al, 2013).…”

“…HRV modifications could also reflect the effect of treatments, such as ventilation, antibiotics, and phototherapy. To date, a clear correlation is still lacking, and better research is needed, although initial evidence is available (Sullivan et al, 2014;Uhrikova et al, 2015;Al-Shargabi et al, 2017;Latremouille et al, 2018). For instance, as RMS S , RMS L , DFA α S , LF, HF, and TP decreased around 48 h before NEC occurred, the same metrics recovered to their baseline values during the first 60 h after NEC diagnosis (Al-Shargabi et al, 2018).…”

Análise da variabilidade da frequência cardíaca como preditora de falha/sucesso da extubação traqueal em pediatria

“…Ela apresenta correlações com os estados do sistema nervoso autônomo72 . Em RN, a VFC demonstra a instabilidade do sistema autonômico antes da deterioração dos sinais clínicos ou dos resultados dos exames laboratoriais, como por exemplo, nos casos de sepse, de desmame da VPM ou nos casos de encefalopatia hipóxico-isquêmica73 . Esta análise pode ser realizada por meio de diferentes métodos, sendo os métodos lineares os mais utilizados na prática clínica72 .…”