title: Pattern of brain injury and depressed heart rate variability in newborns with hypoxic ischemic encephalopathy.
abstract: BackgroundDecreased heart rate variability (HRV) is a measure of autonomic dysfunction and brain injury in newborns with hypoxic ischemic encephalopathy (HIE). This study aimed to characterize the relationship between HRV and brain injury pattern using magnetic resonance imaging (MRI) in newborns with HIE undergoing therapeutic hypothermia.MethodsHRV metrics were quantified in the time domain (αS, αL, and root mean square at short (RMSS) and long (RMSL) timescales) and frequency domain (relative low-(LF) and high-frequency (HF) power) over 24-27 h of life. The brain injury pattern shown by MRI was classified as no injury, pure cortical/white matter injury, mixed watershed/mild basal ganglia injury, predominant basal ganglia or global injury, and death. HRV metrics were compared across brain injury pattern groups using a random-effects mixed model.ResultsData from 74 infants were analyzed. Brain injury pattern was significantly associated with the degree of HRV suppression. Specifically, negative associations were observed between the pattern of brain injury and RMSS(estimate -0.224, SE 0.082, P=0.006), RMSL(estimate -0.189, SE 0.082, P=0.021), and LF power (estimate -0.044, SE 0.016, P=0.006).ConclusionDegree of HRV depression is related to the pattern of brain injury. HRV monitoring may provide insights into the pattern of brain injury at the bedside.
authors.affiliation: Division of Fetal and Transitional Medicine, Children's National Health System, Washington, DC.
authors.forename: Marina
authors.initials: M
authors.lastname: Metzler
authors.affiliation: Division of Fetal and Transitional Medicine, Children's National Health System, Washington, DC.
authors.forename: Rathinaswamy
authors.initials: R
authors.lastname: Govindan
authors.affiliation: Division of Fetal and Transitional Medicine, Children's National Health System, Washington, DC.
authors.forename: Tareq
authors.initials: T
authors.lastname: Al-Shargabi
authors.affiliation: Division of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Vezina
authors.affiliation: Divsion of Neonatology, Children's National Health System, Washington, DC.
authors.forename: Nickie
authors.initials: N
authors.lastname: Andescavage
authors.affiliation: Division of Biostatistics and Study Methodology, Children's National Health System, Washington, DC.
authors.forename: Yunfei
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Division of Fetal and Transitional Medicine, Children's National Health System, Washington, DC.
authors.forename: Adre
authors.initials: A
authors.lastname: du Plessis
authors.affiliation: Divsion of Neonatology, Children's National Health System, Washington, DC.
authors.forename: An N
authors.initials: AN
authors.lastname: Massaro
mesh_terms: D005260:Female; D006339:Heart Rate; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000503:physiopathology*; D007231:Infant, Newborn; D008297:Male