The Critical Role of the Central Autonomic Nervous System in Fetal-Neonatal Transition

Mulkey, Sarah B.; Plessis, Adré du

doi:10.1016/j.spen.2018.05.004

Cited by 46 publications

(59 citation statements)

References 94 publications

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“…This premature engagement of the ANS under the condition of premature birth may result in “ dysmaturation ”, or a shift in the temporal program of ANS maturation due to aberrant programming. (6, 7)…”

Section: Introductionmentioning

confidence: 99%

Autonomic nervous system depression at term in neurologically normal premature infants

Mulkey

Kota

Swisher

et al. 2018

Early Human Development

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Section: Introductionmentioning

confidence: 99%

Autonomic nervous system depression at term in neurologically normal premature infants

Mulkey

Kota

Swisher

et al. 2018

Early Human Development

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“… 1 , 20 , 21 Within the central ANS, brainstem and hypothalamic centers develop first and develop multiple, complex connections with supratentorial structures, including the insula, the anterior thalamus, the anterior cingulate gyrus, the hippocampus, the hypothalamus, and the amygdala, later in gestation and during the early neonatal period. 5 , 22 Overall, sympathetic innervation develops and begins exerting influence earliest, with an increase in parasympathetic influence over time as higher cortical processes begin to integrate autonomic control during late gestation and the early neonatal period. 23 , 24 …”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have described an association between preterm birth and subsequent extrauterine maturation on the developing ANS. 5 – 8 However, there are multiple potential factors beyond birth gestational age (GA) that may influence ANS development in the extrauterine environment. We recently studied a relatively low-morbidity population of premature infants and found no significant association between duration of preterm extrauterine maturation and metrics of ANS development from birth to term-corrected age.…”

Section: Introductionmentioning

confidence: 99%

Autonomic development in preterm infants is associated with morbidity of prematurity

et al. 2021

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Background Previous studies have described an association between preterm birth and maturation of the autonomic nervous system (ANS); however, this may be impacted by multiple factors, including prematurity-related complications. Our aim was to evaluate for the effect of prematurity-related morbidity on ANS development in preterm infants in the NICU. Methods We compared time and frequency domains of heart rate variability (HRV) as a measure of ANS tone in 56 preterm infants from 2 NICUs (28 from each). One cohort was from a high-morbidity regional referral NICU, the other from a community-based inborn NICU with low prematurity-related morbidity. Propensity score matching was used to balance the groups by a 1:1 nearest neighbor design. ANS tone was analyzed. Results The two cohorts showed parallel maturational trajectory of the alpha 1 time-domain metric, with the cohort from the high-morbidity NICU having lower autonomic tone. The maturational trajectories between the two cohorts differed in all other time-domain metrics (alpha 2, RMS1, RMS2). There was no difference between groups by frequency-domain metrics. Conclusions Prematurity-associated morbidities correlate with autonomic development in premature infants and may have a greater impact on the extrauterine maturation of this system than birth gestational age. Impact Autonomic nervous system development measured by time-domain metrics of heart rate variability correlate with morbidities associated with premature birth. This study builds upon our previously published work that showed that development of autonomic tone was not impacted by gestational age at birth. This study adds to our understanding of autonomic nervous system development in a preterm extrauterine environment. Our study suggests that gestational age at birth may have less impact on autonomic nervous system development than previously thought.

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“…Meanwhile, fetal movements and HR increase indicate a rise in the SNS activity (DiPietro et al, 1996). The ANS regulatory function, especially the parasympathetic, develops until birth when the ANS has to react to the new environmental conditions by adapting the cardiovascular and respiratory systems during the fetal-neonatal transition (Mulkey and du Plessis, 2018).…”

Section: The Ans Development and Its Relationship With 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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The Critical Role of the Central Autonomic Nervous System in Fetal-Neonatal Transition

Cited by 46 publications

References 94 publications

Autonomic nervous system depression at term in neurologically normal premature infants

Autonomic nervous system depression at term in neurologically normal premature infants

Autonomic development in preterm infants is associated with morbidity of prematurity

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

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