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. 2017 Sep;82(3):438-443.
doi: 10.1038/pr.2017.94. Epub 2017 May 3.

Pattern of brain injury and depressed heart rate variability in newborns with hypoxic ischemic encephalopathy

Marina Metzler  1 , Rathinaswamy Govindan  1 , Tareq Al-Shargabi  1 , Gilbert Vezina  2 , Nickie Andescavage  3 , Yunfei Wang  4 , Adre du Plessis  1 , An N Massaro  3
Affiliations

Pattern of brain injury and depressed heart rate variability in newborns with hypoxic ischemic encephalopathy

Marina Metzler et al. Pediatr Res. 2017 Sep.

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.

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Conflict of interest statement

Potential Conflicts of interest / Disclosures: All authors have nothing to disclose.

Figures

Figure 1
Figure 1. DFA Metrics
Detrended fluctuation analysis (DFA) metrics: (a) αS, (b) αL, (c) root mean square at short (RMSS) and (d) long (RMSL) time scales presented as median (interquartile range). Injury pattern groups are defined as: 0=no injury, 1=pure cortical/WMI, 2=mixed WS/mild BN, 3= predominant BN or global injury, and 4=died. Detrended fluctuation analysis (DFA) metrics: (a) αS, (b) αL, (c) root mean square at short (RMSS) and (d) long (RMSL) time scales presented as median (interquartile range). Injury pattern groups are defined as: 0=no injury, 1=pure cortical/WMI, 2=mixed WS/mild BN, 3= predominant BN or global injury, and 4=died.
Figure 2
Figure 2. SA Metrics
Spectral analysis (SA) metrics a) relative low frequency (rLF) and b) high frequency (rHF) power presented as median (interquartile range). Absolute c) LF and d) HF power are also shown for comparison. Injury pattern groups are defined as: 0=no injury, 1=pure cortical/WMI, 2=mixed WS/mild BN, 3= predominant BN or global injury, and 4=died. Spectral analysis (SA) metrics a) relative low frequency (rLF) and b) high frequency (rHF) power presented as median (interquartile range). Absolute c) LF and d) HF power are also shown for comparison. Injury pattern groups are defined as: 0=no injury, 1=pure cortical/WMI, 2=mixed WS/mild BN, 3= predominant BN or global injury, and 4=died.
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