Autonomic dysfunction with early respiratory syncytial virus-related infection.
BACKGROUND
Apparent life-threatening events (ALTE) and/or prolonged apnoea have been well-documented during respiratory syncytial virus (RSV) infection in infants less than 2 months of age but fundamental mechanisms remain unclear. The possibility of a central origin for the development of severe cardiac and respiratory events encouraged us, to explore the autonomic nervous system (ANS) profile of infected infants, since ANS activity may contribute to the constellation of symptoms observed during severe forms of RSV bronchiolitis.


METHODS
Eight infants (2 preterm and 6 full-term) less than 2 months of age and presenting with severe and apnoeic forms of RSV infection were evaluated using non-invasive electrophysiological monitoring obtained simultaneously for approximately 2 consecutive hours, including a quiet sleep period. Eight control subjects, paired for gestational and postnatal age, were also evaluated. ANS status was monitored using electrocardiogram recordings and quantified through a frequency-domain analysis of heart rate variability (HRV). This included sympathetic (VLF and LF) and parasympathetic (HF) indices as well as a measure of baroreflex sensitivity (BRS) obtained using non-invasive continuous arterial pressure.


RESULTS
Regardless of gestational and postnatal age, heart rate variability components (Ptot, VLF, LF, and HF) and baroreflex components (alpha LF, alpha HF and sBR) were found to be significantly lower in the RSV-infected group than in the control group (p<0.05).


CONCLUSIONS
RSV infection in neonates is associated with profound central autonomic dysfunction. The potentially fatal consequence stresses the importance of maintaining prolonged cardiopulmonary monitoring.
Stock
Claire
C
Paediatric Department, Intensive Care and Neonatology Unit, University Hospital of Saint-Etienne, 42055 Saint-Etienne, Cedex 02, France.
Teyssier
Georges
G
Pichot
Vincent
V
Goffaux
Philippe
P
Barthelemy
Jean-Claude
JC
Patural
Hugues
H
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001341:Autonomic Nervous System / Q000503:physiopathology* / Q000821:virology*; D017704:Baroreflex / Q000502:physiology*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis / Q000503:physiopathology* / Q000821:virology; D012136:Respiratory Syncytial Viruses / Q000502:physiology; D012890:Sleep / Q000502:physiology*; D017735:Virus Latency / Q000502:physiology; D055815:Young Adult