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Clinical Autonomic Research
Published in: Clinical Autonomic Research 2/2020

01-04-2020 | Research Article

Heart rate variability is depressed in the early transitional period for newborns with complex congenital heart disease

Authors: Sarah B. Mulkey, Rathinaswamy Govindan, Marina Metzler, Christopher B. Swisher, Laura Hitchings, Yunfei Wang, Robin Baker, G. Larry Maxwell, Anita Krishnan, Adre J. du Plessis

Published in: Clinical Autonomic Research | Issue 2/2020

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Abstract

Purpose

To compare early changes in autonomic nervous system (ANS) tone between newborns with complex congenital heart disease (CHD) and newborns without CHD.

Methods

We performed a case–control study of heart rate variability (HRV) in newborns with complex CHD [transposition of the great arteries (TGA) or hypoplastic left heart syndrome (HLHS)] and low-risk control newborns without CHD. Cases with CHD were admitted following birth to a pediatric cardiac intensive care unit and had archived continuous ECG data. Control infants were prospectively enrolled at birth. ECG data in cases and controls were analyzed for HRV in the time and frequency domains at 24 h of age. We analyzed the following HRV metrics: alpha short (αs), alpha long (αL), root mean square short and long (RMSs and RMSL), low-frequency (LF) power, normalized LF (nLF), high-frequency (HF) power, and normalized HF (nHF). We used ANOVA to compare HRV metrics between groups and to control for medication exposures.

Results

HRV data from 57 infants with CHD (TGA, n = 33 and HLHS, n = 24) and from 29 controls were analyzed. The HRV metrics αS, RMSL, LF, and nLF were significantly lower in infants with CHD than in the controls. Due to the effect of normalization, nHF was higher in CHD infants (P < 0.0001), although absolute HF was lower (P = 0.0461). After adjusting for medications, αS and nLF remained lower and nHF higher in newborns with CHD (P  < 0.0005).

Conclusions

Infants with complex CHD have depressed autonomic balance in the early postnatal period, which may complicate the fetal–neonatal transition.
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Metadata
Title
Heart rate variability is depressed in the early transitional period for newborns with complex congenital heart disease
Authors
Sarah B. Mulkey
Rathinaswamy Govindan
Marina Metzler
Christopher B. Swisher
Laura Hitchings
Yunfei Wang
Robin Baker
G. Larry Maxwell
Anita Krishnan
Adre J. du Plessis
Publication date
01-04-2020
Publisher
Springer Berlin Heidelberg
Published in
Clinical Autonomic Research / Issue 2/2020
Print ISSN: 0959-9851
Electronic ISSN: 1619-1560
DOI
https://doi.org/10.1007/s10286-019-00616-w

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