Abstract
Background
Previous studies have described an association between preterm birth and maturation of the autonomic nervous system (ANS); however, this may be impacted by multiple factors, including prematurity-related complications. Our aim was to evaluate for the effect of prematurity-related morbidity on ANS development in preterm infants in the NICU.
Methods
We compared time and frequency domains of heart rate variability (HRV) as a measure of ANS tone in 56 preterm infants from 2 NICUs (28 from each). One cohort was from a high-morbidity regional referral NICU, the other from a community-based inborn NICU with low prematurity-related morbidity. Propensity score matching was used to balance the groups by a 1:1 nearest neighbor design. ANS tone was analyzed.
Results
The two cohorts showed parallel maturational trajectory of the alpha 1 time-domain metric, with the cohort from the high-morbidity NICU having lower autonomic tone. The maturational trajectories between the two cohorts differed in all other time-domain metrics (alpha 2, RMS1, RMS2). There was no difference between groups by frequency-domain metrics.
Conclusions
Prematurity-associated morbidities correlate with autonomic development in premature infants and may have a greater impact on the extrauterine maturation of this system than birth gestational age.
Impact
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Autonomic nervous system development measured by time-domain metrics of heart rate variability correlate with morbidities associated with premature birth.
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This study builds upon our previously published work that showed that development of autonomic tone was not impacted by gestational age at birth.
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This study adds to our understanding of autonomic nervous system development in a preterm extrauterine environment.
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Our study suggests that gestational age at birth may have less impact on autonomic nervous system development than previously thought.
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Acknowledgements
This study was supported by the Children’s National Inova Collaborative (CNICA) Research Program, through institutional support from Children’s National Hospital, Washington, DC and the Inova Health System, Fairfax, VA. S.B.M. received support by Award Numbers UL1TR001876 and KL2TR001877 from the NIH National Center for Advancing Translational Sciences. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.
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S.D.S. drafted the manuscript and participated in the study design, clinical data collection for the Children’s National cohort, and interpretation of study results. R.B.G. participated in the study design and data analysis and provided critical review of the manuscript. S.D.B. performed statistical analysis for the study and provided critical review of the manuscript. T.A.-S. collected data at INOVA, analyzed heart rate variability data, and provided critical review of the manuscript. D.A.R. and S.I. performed clinical data collection for the Children’s National cohort and provided critical review of the manuscript. L.H. was responsible for participant consent, enrollment, and clinical data collection for the INOVA cohort as well as providing critical review of the manuscript. G.L.M. and R.B. provided critical review of the manuscript. A.J.d.P. participated in the study design and critical review of the manuscript. S.B.M. designed the study, interpreted the study results, and provided critical review of the manuscript. All authors have reviewed and approved the final version of this manuscript.
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Informed consent was obtained for subjects enrolled in our prospective study at Inova Fairfax Hospital, Fairfax, VA. Subjects at Children’s National Hospital were enrolled in a retrospective study with a waiver of informed consent.
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Schlatterer, S.D., Govindan, R.B., Barnett, S.D. et al. Autonomic development in preterm infants is associated with morbidity of prematurity. Pediatr Res 91, 171–177 (2022). https://doi.org/10.1038/s41390-021-01420-x
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DOI: https://doi.org/10.1038/s41390-021-01420-x
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