Department of Medical Sciences, Paediatric Section, University of Ferrara, Italy; Pediatric University Hospital, Padova, Italy.
Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Italy.
Eur J Paediatr Neurol. 2020 Nov;29:66-70. doi: 10.1016/j.ejpn.2020.08.004. Epub 2020 Aug 20.
Major deficits in the autonomic nervous system function, detected by measuring heart rate variability (HRV), are reported in neonatal hypoxic-ischemic encephalopathy (HIE)). However, it is unknown if they will recover in the long-term. Because of the possible implications for the neurological outcome, this study aimed to evaluate the HRV at school age, in a cohort of children who survived HIE managed with therapeutic hypothermia.
A cross-sectional study of HRV in 40 children: 20 HIE survivors and 20 healthy peers. All underwent 5-min plethysmography using the PPG Stress Flow device (BioTekna Italy). Absolute and normalized HRV spectral power in the very low frequency (VLF), low frequency (LF), and high frequency (HF) bands and total power were compared between patients and healthy children. The outcome evaluation included neurological, cognitive (WISC-IV), and psychosocial (Parent Stress Index-Short Form-PSI-SF and psychosocial interview) measures.
All mean HRV values were significantly higher in survivors of HIE, compared to healthy peers, with the larger effect size for the HF band (Total Power 8.57 ± 0.59 vs 7.82 ± 0.77 ms, p .003 ES 0.21; HF 7.82 + 0.77 vs 8.57 + 0.59 ms, p .001 EF 0.24). None of the children had major health, neurological and psychosocial (PSI-SF/interview) problems. The IQ (WISC-IV) was normal in 17/20 patients, borderline in 2, and <70 in 1.
HRV measures highlight autonomic dysfunction at school age in survivors of neonatal HIE, in the absence of major neurodevelopmental and psychosocial problems. The significance of this finding for children's future life needs further neuropsychiatric investigations and longer follow-up.
通过心率变异性（HRV）测量，发现新生儿缺氧缺血性脑病（HIE）患者的自主神经系统功能存在严重缺陷。然而，目前尚不清楚这些缺陷是否会在长期内得到恢复。由于其对神经发育结局可能存在影响，本研究旨在评估接受治疗性低温治疗的 HIE 存活患儿在学龄期的 HRV。
这是一项 HRV 的病例对照研究，共纳入 40 名儿童：20 名 HIE 幸存者和 20 名健康对照。所有儿童均使用 PPG Stress Flow 设备（意大利 BioTekna）进行 5 分钟的容积描记法。比较患者与健康儿童之间极低频（VLF）、低频（LF）和高频（HF）带以及总功率的绝对和归一化 HRV 谱功率。结局评估包括神经学、认知（WISC-IV）和心理社会（父母压力指数-短式量表-PSI-SF 和心理社会访谈）方面的评估。
与健康对照组相比，HIE 幸存者的所有平均 HRV 值均显著升高，HF 带的效应量更大（总功率 8.57±0.59 比 7.82±0.77 ms，p<.003，ES 0.21；HF 7.82±0.77 比 8.57±0.59 ms，p<.001，EF 0.24）。没有儿童存在重大健康、神经和心理社会（PSI-SF/访谈）问题。20 名患儿中有 17 名的智商（WISC-IV）正常，2 名处于边缘水平，1 名低于 70。
在没有重大神经发育和心理社会问题的情况下，HRV 测量在新生儿 HIE 幸存者的学龄期突出了自主神经功能障碍。这一发现对儿童未来生活的意义需要进一步的神经精神病学研究和更长时间的随访。
