Smolkova Magdalena, Sekar Shivani, Kim Seh Hyun, Sunwoo John, El-Dib Mohamed
School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Pediatr Res. 2024 Oct 5. doi: 10.1038/s41390-024-03606-5.
Infants born preterm are at higher risk of neurological complications, including intraventricular haemorrhage and white matter injury. After discharge, these infants may experience adverse neurodevelopmental outcomes and exhibit lower educational attainment. Early detection of brain injury and accurate prediction of neurodevelopmental impairment would allow early intervention and support. Heart rate variability (HRV) describes the variation of time intervals between each subsequent heartbeat. HRV is controlled by the autonomic nervous system, which may be affected by hypoxia and compromised blood flow. While HRV has primarily been investigated in neonatal sepsis, the association between HRV, brain injury and neurodevelopmental outcomes in preterm infants is less established. The present scoping review examines the utility of HRV monitoring for predicting short-term and long-term neurological outcomes in preterm infants. Following systematic search of Medline, Embase, Web of Science and the Cochrane Library, 15 studies were included. Nine studies examined the relationship between HRV and brain injury, with all but two showed an association. Eight studies examined the relationship between HRV and long-term outcomes and all eight found an association. This scoping review suggests that decreased HRV in the neonatal period is associated with short- and long-term neurodevelopmental outcomes in preterm infants. IMPACT: Changes in heart rate variability correlate with the occurrence of intraventricular haemorrhage in preterm infants. A decrease in heart rate variability may precede the development of intraventricular haemorrhage. Alterations in heart rate variability correlate with long-term neurodevelopmental outcomes. Significant variability exists in metrics used in assessing heart rate variability.
早产出生的婴儿出现神经并发症的风险更高，包括脑室内出血和白质损伤。出院后，这些婴儿可能会出现不良的神经发育结果，并表现出较低的教育成就。早期发现脑损伤并准确预测神经发育障碍将有助于早期干预和支持。心率变异性（HRV）描述了连续心跳之间时间间隔的变化。HRV受自主神经系统控制，自主神经系统可能受到缺氧和血流受损的影响。虽然HRV主要在新生儿败血症中进行了研究，但HRV与早产儿脑损伤和神经发育结果之间的关联尚不太明确。本综述探讨了HRV监测对预测早产儿短期和长期神经学结果的效用。在对Medline、Embase、科学网和考克兰图书馆进行系统检索后，纳入了15项研究。9项研究探讨了HRV与脑损伤之间的关系，除两项研究外，所有研究均显示存在关联。8项研究探讨了HRV与长期结果之间的关系，所有8项研究均发现存在关联。本综述表明，新生儿期HRV降低与早产儿短期和长期神经发育结果相关。影响：心率变异性的变化与早产儿脑室内出血的发生相关。心率变异性降低可能在脑室内出血发生之前出现。心率变异性的改变与长期神经发育结果相关。在评估心率变异性时使用的指标存在显著差异。
