Andersen Mads, Andelius Ted C K, Pedersen Mette V, Kyng Kasper J, Henriksen Tine B
Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.
BMC Pediatr. 2019 Jul 19;19(1):242. doi: 10.1186/s12887-019-1603-7.
Several studies have investigated heart rate variability (HRV) as a biomarker for acute brain injury in hypoxic ischemic encephalopathy (HIE). However, the current evidence is heterogeneous and needs further reviewing to direct future studies. We aimed to systematically review whether HIE severity is associated with HRV.
This systematic review was conducted according to the preferred reporting items for systematic review and meta analyses (PRISMA). We included studies comparing neonates with severe or moderate HIE with neonates with mild or no HIE with respect to different HRV measures within 7 days of birth. Article selection and quality assessment was independently performed by two reviewers. Risk of bias and strength of evidence was evaluated by the Newcastle-Ottawa scale (NOS) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE).
We screened 1187 studies. From these, four observational studies with 248 neonates were included. For all HRV measures, the strength of evidence was very low. Neonates with severe or moderate HIE showed a reduction in most HRV measures compared to neonates with mild or no HIE with a greater reduction in those with severe HIE.
Moderate and severe HIE was associated with a reduction in most HRV measures. Accordingly, HRV is a potential biomarker for HIE severity during the first week of life. However, the uncertainty calls for more studies.
多项研究已将心率变异性（HRV）作为缺氧缺血性脑病（HIE）急性脑损伤的生物标志物进行了调查。然而，目前的证据参差不齐，需要进一步审查以指导未来的研究。我们旨在系统评价HIE严重程度是否与HRV相关。
本系统评价按照系统评价和Meta分析的首选报告项目（PRISMA）进行。我们纳入了在出生7天内比较重度或中度HIE新生儿与轻度或无HIE新生儿不同HRV指标的研究。由两名评价员独立进行文献筛选和质量评估。采用纽卡斯尔-渥太华量表（NOS）和推荐分级的评估、制定与评价（GRADE）对偏倚风险和证据强度进行评估。
我们筛选了1187项研究。从中纳入了4项观察性研究，共248例新生儿。对于所有HRV指标，证据强度都非常低。与轻度或无HIE的新生儿相比，重度或中度HIE的新生儿大多数HRV指标降低，重度HIE的新生儿降低幅度更大。
中度和重度HIE与大多数HRV指标降低有关。因此，HRV是出生后第一周内HIE严重程度的潜在生物标志物。然而，由于存在不确定性，需要更多的研究。
