Altered heart rhythm dynamics in very low birth weight infants with impending intraventricular hemorrhage.
OBJECTIVE
Intraventricular hemorrhage remains an important problem among very low birth weight infants and may result in long-term neurodevelopmental disabilities. Neonatologists have been unable to accurately predict impending intraventricular hemorrhage. Because alterations in the autonomic nervous system's control of heart rhythm have been associated with intraventricular hemorrhage after its development, we sought to determine if early subtle alterations of heart rhythm could be predictive of impending intraventricular hemorrhage in very low birth weight infants.


METHODS
This case-control study included 10 newborn very low birth weight infants with intraventricular hemorrhage (5 grade IV, 4 grade III, and 1 grade II) and 14 control infants without intraventricular hemorrhage. Heart rhythm data from the first day of life before the development of intraventricular hemorrhage were evaluated. Detrended fluctuation analysis, a nonlinear fractal heart rate variability method, was used to assess the fractal dynamics of the heart rhythm. Fractal scaling exponents were calculated by using this analysis.


RESULTS
Twenty-four infants (mean +/- SD, birth weight: 845 +/- 213g: gestational age: 26.1 +/- 1.9 weeks) participated in the study. The short-term scaling exponent was significantly larger in infants who later developed intraventricular hemorrhage compared with those who did not (0.60 +/- 0.1 vs 0.45 +/- 0.1). A value of 0.52 resulted in 70% sensitivity and positive predictive value and 79% specificity and negative predictive value. The short-term scaling exponent was the only significant predictor of intraventricular hemorrhage.


CONCLUSIONS
Fractal dynamics of the heart rhythm is significantly altered in very low birth weight infants before developing intraventricular hemorrhage and may be predictive of impending intraventricular hemorrhage.
Tuzcu
Volkan
V
Arkansas Children's Hospital, Division of Cardiology, 1900 Maryland, Mail Slot 512-3, Little Rock, AR 72202, USA. tuzcuvolkan@uams.edu
Nas
Selman
S
Ulusar
Umit
U
Ugur
Ahmet
A
Kaiser
Jeffrey R
JR
D001341:Autonomic Nervous System / Q000503:physiopathology; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000503:physiopathology*; D002552:Cerebral Ventricles; D042241:Early Diagnosis; D004453:Echoencephalography; D004562:Electrocardiography; D005260:Female; D017709:Fractals; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000503:physiopathology*; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D017711:Nonlinear Dynamics; D011237:Predictive Value of Tests; D011336:Probability; D012372:ROC Curve; D012815:Signal Processing, Computer-Assisted