title: Abnormal heart rate characteristics are associated with abnormal neuroimaging and outcomes in extremely low birth weight infants.
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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  A continuously monitored HRC index provides an objective, noninvasive measure associated with abnormal brain imaging and adverse neurologic outcomes in ELBW infants.
authors.affiliation: Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: K D
authors.initials: KD
authors.lastname: Fairchild
authors.affiliation: Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: R A
authors.identifier: 0000000235800329
authors.initials: RA
authors.lastname: Sinkin
authors.affiliation: Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: F
authors.initials: F
authors.lastname: Davalian
authors.affiliation: Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: A E
authors.initials: AE
authors.lastname: Blackman
authors.affiliation: Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Swanson
authors.affiliation: Department of Radiology, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Matsumoto
authors.affiliation: Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: D E
authors.initials: DE
authors.lastname: Lake
authors.affiliation: Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Moorman
authors.affiliation: Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Blackman
mesh_terms: D001724:Birth Weight; D001930:Brain Injuries / Q000151:congenital* / Q000175:diagnosis / Q000000981:diagnostic imaging; D002543:Cerebral Hemorrhage / Q000175:diagnosis; D002657:Child Development; D005865:Gestational Age; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007223:Infant; D052577:Infant, Extremely Low Birth Weight / Q000502:physiology*; D007231:Infant, Newborn; D007969:Leukomalacia, Periventricular / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D059906:Neuroimaging; D018805:Sepsis; D014463:Ultrasonography