Early postnatal heart rate variability in healthy newborn infants
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Published version
Author(s)
Type
Journal Article
Abstract
Background: Despite the increasing interest in fetal and neonatal heart rate variability (HRV) analysis and its potential use as a tool for early disease stratification, no studies have previously described the normal trends of HRV in healthy babies during the first hours of postnatal life. Methods: We prospectively recruited 150 healthy babies from the postnatal ward and continuously recorded their electrocardiogram during the first 24 h after birth. Babies were included if born in good condition and stayed with their mother. Babies requiring any medication or treatment were excluded. Five-minute segments of the electrocardiogram (non-overlapping time-windows) with more than 90% consecutive good quality beats were included in the calculation of hourly medians and interquartile ranges to describe HRV trends over the first 24 h. We used multilevel mixed effects regression with auto-regressive covariance structure for all repeated measures analysis and t-tests to compare group differences. Non-normally distributed variables were log-transformed. Results: Nine out of 16 HRV metrics (including heart rate) changed significantly over the 24 h [Heart rate p < 0.01; Standard deviation of the NN intervals p = 0.01; Standard deviation of the Poincaré plot lengthwise p < 0.01; Cardiac sympathetic index (CSI) p < 0.01; Normalized high frequency power p = 0.03; Normalized low frequency power p < 0.01; Total power p < 0.01; HRV index p = 0.01; Parseval index p = 0.03], adjusted for relevant clinical variables. We observed an increase in several HRV metrics during the first 6 h followed by a gradual normalization by approximately 12 h of age. Between 6 and 12 h of age, only heart rate and the normalized low frequency power changed significantly, while between 12 and 18 h no metric, other than heart rate, changed significantly. Analysis with multilevel mixed effects regression analysis (multivariable) revealed that gestational age, reduced fetal movements, cardiotocography and maternal chronic or pregnancy induced illness were significant predictors of several HRV metrics. Conclusion: Heart rate variability changes significantly during the first day of life, particularly during the first 6 h. The significant correlations between HRV and clinical risk variables support the hypothesis that HRV is a good indicator of overall wellbeing of a baby and is sensitive to detect birth-related stress and monitor its resolution over time.
Date Issued
2019-08-07
Date Acceptance
2019-07-08
ISSN
1664-042X
Publisher
Frontiers Media
Start Page
1
End Page
12
Journal / Book Title
Frontiers in Physiology
Volume
10
Issue
922
Copyright Statement
© 2019 Oliveira, von Rosenberg, Montaldo, Adjei, Mendoza,
Shivamurthappa, Mandic and Thayyil. This is an open-access article distributed
under the terms of the Creative Commons Attribution License (CC BY)(http://creativecommons.org/licenses/by/4.0/). The use,
distribution or reproduction in other forums is permitted, provided the original
author(s) and the copyright owner(s) are credited and that the original publication
in this journal is cited, in accordance with accepted academic practice. No use,
distribution or reproduction is permitted which does not comply with these terms.
Shivamurthappa, Mandic and Thayyil. This is an open-access article distributed
under the terms of the Creative Commons Attribution License (CC BY)(http://creativecommons.org/licenses/by/4.0/). The use,
distribution or reproduction in other forums is permitted, provided the original
author(s) and the copyright owner(s) are credited and that the original publication
in this journal is cited, in accordance with accepted academic practice. No use,
distribution or reproduction is permitted which does not comply with these terms.
Sponsor
National Institute for Health Research
Imperial College Healthcare NHS Trust
Medical Research Council (MRC)
Identifier
https://www.frontiersin.org/articles/10.3389/fphys.2019.00922/full
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000479165000001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Grant Number
NIHR/CS/010/022
RDD10
MR/R001375/1
Subjects
Science & Technology
Life Sciences & Biomedicine
Physiology
heart rate variability
healthy
term
infant
newborn
AUTONOMIC FUNCTION
BEHAVIORAL STATES
FETAL
STRESS
SLEEP
1ST
Science & Technology
Life Sciences & Biomedicine
Physiology
heart rate variability
healthy
term
infant
newborn
AUTONOMIC FUNCTION
BEHAVIORAL STATES
FETAL
STRESS
SLEEP
1ST
Publication Status
Published
Article Number
ARTN 922
Date Publish Online
2019-08-07