title: The Impact of Surgical Patent Ductus Arteriosus Closure on Autonomic Function in Premature Infants.
abstract: BackgroundPatent ductus arteriosus (PDA) is a common complication of prematurity and a risk factor for poor outcome. Infants undergoing surgical PDA ligation are at highest risk for neurodevelopmental injury. Autonomic dysfunction has been described in premature infants with PDA.AimTo interrogate the autonomic nervous system by analysis of advanced heart rate variability (HRV) metrics before and after surgical closure of the PDA.Study DesignProspective, observational study.SubjectsTwenty-seven infants born before 28 weeks' gestation were included in this study.MethodsContinuous electrocardiogram data were sampled at a rate of 125 Hz for a total of 6 hours before and 6 hours after 30 hours of surgical closure. HRV was determined by detrended fluctuation analysis to calculate the short and long root mean square (RMSLand RMSS) and α components at two time scales (long and short).ResultsGestational age (GA) was positively associated with RMSL, RMSS, and αSand was negatively associated with αL. There was no difference between RMSs, RMSL, αS, or αLbefore and after surgery; however, median heart rate was lower after surgery (p< 0.01).ConclusionAdvancing GA is highly associated with increasing HRV; however, surgical ligation does not affect HRV in the postoperative period.
authors.affiliation: Division of Neonatology, Children's National Health System, Washington, District of Columbia.|Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia.
authors.forename: Nickie N
authors.initials: NN
authors.lastname: Andescavage
authors.affiliation: Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia.
authors.forename: Marina
authors.initials: M
authors.lastname: Metzler
authors.affiliation: Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia.
authors.forename: Vedavalli
authors.initials: V
authors.lastname: Govindan
authors.affiliation: Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia.
authors.forename: Tareq
authors.initials: T
authors.lastname: Al-Shargabi
authors.affiliation: Division of Cardiovascular Surgery, Children's National Health System, Washington, District of Columbia.
authors.forename: Dilip S
authors.initials: DS
authors.lastname: Nath
authors.affiliation: Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia.|Division of Cardiology, Children's National Health System, Washington, District of Columbia.
authors.forename: Anita
authors.initials: A
authors.lastname: Krishnan
authors.affiliation: Division of Neonatology, Children's National Health System, Washington, District of Columbia.|Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia.
authors.forename: An
authors.initials: A
authors.lastname: Massaro
authors.affiliation: Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia.|Division of Biostatistics and Study Methodology, Children's National Health System, Washington, District of Columbia.
authors.forename: Yunfei
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia.|Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia.
authors.forename: Adre J
authors.initials: AJ
authors.lastname: duPlessis
authors.affiliation: Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia.
authors.forename: R B
authors.initials: RB
authors.lastname: Govindan
mesh_terms: D001341:Autonomic Nervous System / Q000503:physiopathology; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000601:surgery*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005865:Gestational Age; D006339:Heart Rate; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D008026:Ligation / Q000009:adverse effects; D008297:Male; D011446:Prospective Studies