title: Cerebral modulation of the autonomic nervous system in term infants.
abstract: Central topography of autonomic nervous system (ANS) function has yet to be fully deciphered. In adults it has been shown to lateralize sympathetic and parasympathetic influence predominantly to the right and left cerebral hemispheres, respectively. We examined functional topography of central ANS in newborn subjects utilizing spectral analysis of heart rate variability (HRV), an established measure of ANS function.
  
  
  
  We studied newborns with hypoxic-ischemic encephalopathy participating in a prospective study undergoing a therapeutic hypothermia protocol.We included subjects with continuous heart rate data over the first 3 h of normothermia (post rewarming) and brain magnetic resonance imaging, which was reviewed and scored according to a 4 region scheme. HRV was evaluated by spectral analysis in the low-frequency (0.05 to 0.25 Hz) and high-frequency (0.3 to 1 Hz) ranges. The relationship between injured brain regions and HRV was studied using multiple regressions.
  
  
  
  Forty eight newborns were included. When examined in isolation, right hemisphere injury had a significant negative effect on HRV (-0.088; 95% CI: -0.225,-0.008). The combination of posterior fossa region injury with right hemispheric injury or left hemispheric injury demonstrated significant positive (0.299; 95% CI: 0.065, 0.518) and negative (-0.475; 95% CI: -0.852, -0.128) influences on HRV, respectively. The association between brain injury location and HRV in the high-frequency range did not reach significance.
  
  
  
  Our data support the notion that lateralized cerebral modulation of the ANS, specifically of its sympathetic component, is present in the term newborn, and suggest complex modulation of these tracts by components of the posterior fossa.
authors.affiliation: Department of Fetal and Transitional Medicine, Fetal Medicine Institute, Children's National Health System, Washington, DC, USA.
authors.forename: N
authors.initials: N
authors.lastname: Schneebaum Sender
authors.affiliation: Department of Fetal and Transitional Medicine, Fetal Medicine Institute, Children's National Health System, Washington, DC, USA.
authors.forename: R B
authors.initials: RB
authors.lastname: Govindan
authors.affiliation: Department of Radiology, Children's National Health System, Washington, DC, USA.
authors.forename: M T
authors.initials: MT
authors.lastname: Whitehead
authors.affiliation: Division of Neonatology and Division of Fetal and Transitional Medicine, Children's National Health Systems Pediatrics, The George Washington University School of Medicine, Washington, DC, USA.
authors.forename: A N
authors.initials: AN
authors.lastname: Massaro
authors.affiliation: Department of Fetal and Transitional Medicine, Fetal Medicine Institute, Children's National Health System, Washington, DC, USA.
authors.forename: M
authors.initials: M
authors.lastname: Metzler
authors.affiliation: Division of Biostatistics and Study Methodology, Center for Translational Science, Children's Research Institute, Children's National Health System, Washington, DC, USA.
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.affiliation: Division of Biostatistics and Study Methodology, Center for Translational Science, Children's Research Institute, Children's National Health System, Washington, DC, USA.
authors.forename: Y I
authors.initials: YI
authors.lastname: Cheng
authors.affiliation: Department of Fetal and Transitional Medicine, Fetal Medicine Institute, Children's National Health System, Washington, DC, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: du Plessis
mesh_terms: D001341:Autonomic Nervous System / Q000503:physiopathology*; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007036:Hypothermia, Induced; D020925:Hypoxia-Ischemia, Brain / Q000503:physiopathology* / Q000628:therapy*; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D012044:Regression Analysis; D047929:Term Birth