title: Heart rate variability evaluation in the assessment and management of in-utero drug-exposed infants.
abstract: OBJECTIVE
  To determine whether heart rate variability parameters vary between in-utero drug-exposed infants and controls. To determine correlations between Finnegan score and heart rate variability parameters. To differentiate those drug-exposed infants who require treatment from those infants who do not.
  
  
  METHODS
  A total of 24 jaundiced control subjects and 25 in-utero drug-exposed infants were enrolled. The Finnegan score and an electrocardiographic rhythm strip were obtained at 4-h intervals. RR intervals (time between consecutive R waves) were manually tabulated from the rhythm strip and analyzed. Time-domain heart rate variability parameters were calculated and analyzed for both groups.
  
  
  RESULTS
  Heart rate variability parameters were cumulatively lower over 3 days in in-utero drug-exposed infants compared with controls (p < 0.05). Root mean square of differences of standard deviation of RR intervals on first day of life, and standard deviation of RR intervals, percentage of consecutive RR intervals greater than 50 ms, and root mean square of differences of standard deviation of RR intervals on the second day of life were significantly lower between in-utero drug-exposed infants and control infants. Three out of five parameters were significantly lower in in-utero drug-exposed infants pre-treatment versus post-treatment (p = 0.001, p = 0.0001, and p = 0.021, respectively). Root mean square of differences of standard deviation of RR intervals was able to differentiate in-utero drug-exposed infants requiring opiate therapy and in-utero drug-exposed infants that did not (p = 0.02).
  
  
  CONCLUSIONS
  Heart rate variability analysis can contribute to the management of in-utero drug-exposed infants. Heart rate variability could be used in dose titration.
authors.affiliation: Department of Pediatric Cardiology, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Nagiub
authors.affiliation: Department of Pediatrics, St. John Providence Children's Hospital, Detroit, MI, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Alton
authors.affiliation: Lake Erie College of Osteopathic Medicine, Erie, PA, USA.
authors.forename: Varun
authors.initials: V
authors.lastname: Avula
authors.affiliation: Graduate Medical Education, St. John Hospital & Medical Center, Detroit, MI, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Hagglund
authors.affiliation: Department of Pediatric Cardiology, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA; Division of Pediatric Cardiology, Department of Pediatrics, St. John Providence Children's Hospital, Detroit, MI, USA.
authors.forename: Premchand
authors.initials: P
authors.lastname: Anne
keywords: Finnegan score; Heart rate variability; neonatal abstinence syndrome