Heart rate variability in hypoxic ischemic encephalopathy during therapeutic hypothermia

Goulding, Robert M.; Stevenson, Nathan J.; Murray, Deirdre M.; Livingstone, Vicki; Filan, Peter M.; Boylan, Geraldine B.

doi:10.1038/pr.2016.245

Cited by 22 publications

(45 citation statements)

References 27 publications

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“…Eight studies were excluded, 2 of which [21, 22] measured the severity of brain injury with methods that did not meet the criteria for this review (Table 4). These studies reported significant differences in mean HRV between severity groups, as well as between survivors and non-survivors.…”

Section: Resultsmentioning

confidence: 99%

Prognostic Accuracy of Heart Rate Variability Analysis in Neonatal Encephalopathy: A Systematic Review

Oliveira¹,

Martins²,

Liow³

et al. 2018

Neonatology

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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.

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Section: Resultsmentioning

confidence: 99%

Prognostic Accuracy of Heart Rate Variability Analysis in Neonatal Encephalopathy: A Systematic Review

Oliveira¹,

Martins²,

Liow³

et al. 2018

Neonatology

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“…A total of 43 fulltext studies were assessed for eligibility. Of these, four studies met the inclusion criteria and were submitted to data extraction and analysis [19][20][21][22]. Furthermore, 139 studies from the reference lists of the included studies were screened but none of these were included (Fig.…”

Section: Study Selectionmentioning

confidence: 99%

“…Goulding et al 2017 [22] included all term neonates with HIE from 2009 to 2014 admitted to a single NICU for therapeutic hypothermia. The HIE eligibility criteria were identical with Goulding et al 2015 [21].…”

Section: Populationsmentioning

confidence: 99%

“…Currently, the only clinical use of HRV is heart rate characteristics (HRC) obtained from HeRO® monitors, which analyze bedside ECG in order to predict onset of sepsis in neonates with very low birth weight [18]. Several studies have found a correlation between HIE and various HRV measures, suggesting that HRV is a potential biomarker for the severity of neonatal HIE [19][20][21][22][23][24][25][26]. However, the current evidence is heterogeneous and needs further reviewing to direct future studies.…”

Section: Introductionmentioning

confidence: 99%

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Severity of hypoxic ischemic encephalopathy and heart rate variability in neonates: a systematic review

et al. 2019

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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. Electronic supplementary material The online version of this article (10.1186/s12887-019-1603-7) contains supplementary material, which is available to authorized users.

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“…For example, the true predictive ability of fetal ECG can only be determined once it is collected at a sampling rate that preserves more of the underlying physiological information. We have demonstrated this approach to assess the severity of hypoxic ischaemic encephalopathy (HIE) in the immediate newborn period (Goulding et al, 2017). Animal and human studies show that the current mode of ECG acquisition is outdated, imprecise, and discards important predictive information (Durosier et al, 2014; Li et al, 2015).…”

mentioning

confidence: 99%

Commentary: Computerised interpretation of fetal heart rate during labour (INFANT): a randomised controlled trial

Frasch

Boylan²,

et al. 2017

Front. Physiol.

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Heart rate variability in hypoxic ischemic encephalopathy during therapeutic hypothermia

Abstract: The HF component of HRV is increased in infants with moderate HIE undergoing TH.

Cited by 22 publications

References 27 publications

Prognostic Accuracy of Heart Rate Variability Analysis in Neonatal Encephalopathy: A Systematic Review

Prognostic Accuracy of Heart Rate Variability Analysis in Neonatal Encephalopathy: A Systematic Review

Severity of hypoxic ischemic encephalopathy and heart rate variability in neonates: a systematic review

Commentary: Computerised interpretation of fetal heart rate during labour (INFANT): a randomised controlled trial

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