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Abnormal heart rate characteristics are associated with abnormal neuroimaging and outcomes in extremely low birth weight infants

Journal of Perinatology volume 34, pages 375–379 (2014)Cite this article

Subjects

Abstract

Objective:

Brain injury in preterm infants may lead to an inflammatory response and central nervous system dysfunction reflected by abnormal heart rate characteristics (HRC). We hypothesized that a continuously monitored HRC index reflecting reduced HR variability and decelerations correlates with abnormal neuroimaging and outcomes in extremely low birth weight infants (ELBW).

Study Design:

We analyzed the average HRC index within 28 days after birth (aHRC28) and head ultrasound (HUS) in 384 ELBW infants. In 50 infants with brain magnetic resonance imaging (MRI) and 70 infants with Bayley neurodevelopmental testing at 1 year of age, we analyzed the relationship between aHRC28, MRI abnormalities and low Bayley scores.

Result:

aHRC28 was higher in infants with severe HUS abnormalities (2.65±1.27 for Grade III-IV intraventricular hemorrhage (IVH) or cystic periventricular leukomalacia (cPVL) versus 1.72±0.95 for normal or Grade I-II IVH, P<0.001). Higher aHRC28 was also associated with white matter damage on MRI and death or Bayley motor or mental developmental index <70. Associations persisted after adjusting for gestational age, birth weight and septicemia. For every one point increase in aHRC28, the odds ratio of death or Bayley score <70 was 2.45 (95% CI 1.46, 4.05, P<0.001).

Conclusion:

A continuously monitored HRC index provides an objective, noninvasive measure associated with abnormal brain imaging and adverse neurologic outcomes in ELBW infants.

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Acknowledgements

We thank Jodi Darring for her work on data collection for this study. This work is supported by NICHD 051609 (KDF), NIGMS 064640 (JRM), NICHD 058672 (JB), and the University of Virginia Children’s Hospital.

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Authors and Affiliations

  1. Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA

    K D Fairchild, R A Sinkin, F Davalian, A E Blackman, J R Swanson & J A Blackman

  2. Department of Radiology, University of Virginia School of Medicine, Charlottesville, VA, USA

    J A Matsumoto

  3. Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA

    D E Lake & J R Moorman

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  1. K D Fairchild
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  2. R A Sinkin
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  7. D E Lake
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Corresponding author

Correspondence to K D Fairchild.

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Competing interests

The heart rate characteristics monitoring randomized clinical trial was supported by NIH (grant R01-HD48562 to J.M.) and by Medical Predictive Science Corporation, Charlottesville, VA, which provided study hardware and software for heart rate characteristics monitoring and for study data collection and management. Neither of these funding sources had any role in the design of the original study or the current report, in the analysis and interpretation of the data, in the decision to submit the manuscript, or in the preparation, review, or approval of it. Dr Lake and Dr Moorman have consulting agreements and equity shares in Medical Predictive Science Corporation, Charlottesville, VA.

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Fairchild, K., Sinkin, R., Davalian, F. et al. Abnormal heart rate characteristics are associated with abnormal neuroimaging and outcomes in extremely low birth weight infants. J Perinatol 34, 375–379 (2014). https://doi.org/10.1038/jp.2014.18

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