Govindan R B, Pezzato Stefano, Ngwa Julius, Krishnan Anita, Panagopoulos Eleni, Chirumamilla Venkata Chaitanya, du Plessis Adre
The Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA; The Developing Brain Institute, Children's National Hospital, Washington, DC, USA; Department of Pediatrics, The George Washington University School of Medicine, Washington, DC, USA.
Neonatal and Pediatric Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy; Division of Cardiac Surgery, Children's National Hospital, Washington, DC, USA.
Early Hum Dev. 2025 Jan;200:106165. doi: 10.1016/j.earlhumdev.2024.106165. Epub 2024 Nov 24.
Neonates with critical congenital heart disease (cCHD) undergo a complicated transition to ex-utero life. However, continuous monitoring of autonomic tone using heart rate variability is currently lacking.
We retrieved continuous electrocardiograms from the time of admission or from 10 days prior to surgery for neonates with dextro-transposition of the great arteries (d-TGA) and hypoplastic left heart syndrome (HLHS). Beat-to-beat intervals (RRi) were calculated and divided into 10-min epochs. Spectral metrics, including low-frequency (LF) and high-frequency (HF) powers, as well as detrended fluctuation analysis metrics (α, α, RMS, and RMS), were computed for RRi within each epoch and averaged over 24 h. The relationship between RRi metrics and time to surgery was analyzed using linear mixed-effects models, adjusting for prenatal and postnatal factors.
The study included 10 neonates with HLHS and 23 with d-TGA. RRi metrics were available for 110 days. In the unadjusted models, LF power (Estimate: -4.4×10, P = 0.02), HF power (-4.1 x 10, 5 x 10), RMS(-3.7 x 10, 8.7 x 10), and RMS(-1.4× 10, 0.02) were all negatively associated with time to surgery, with HF power showing the strongest association. After adjusting for covariates, HF power retained its significant negative association with time (-0.04, P = 0.03). The cCHD diagnosis did not significantly influence RRi metrics.
In neonates with cCHD, there is a progressive decline in autonomic function leading up to surgery. RRi metrics may serve as valuable indicators of deteriorating physiology in these patients.
患有严重先天性心脏病（cCHD）的新生儿在向宫外生活过渡时经历复杂过程。然而，目前缺乏使用心率变异性对自主神经张力进行持续监测。
我们检索了患有大动脉转位（d-TGA）和左心发育不全综合征（HLHS）的新生儿入院时或手术前10天的连续心电图。计算逐搏间期（RRi）并将其分为10分钟的时段。对每个时段内的RRi计算频谱指标，包括低频（LF）和高频（HF）功率，以及去趋势波动分析指标（α、α、RMS和RMS），并在24小时内进行平均。使用线性混合效应模型分析RRi指标与手术时间之间的关系，并对产前和产后因素进行校正。
该研究纳入了10例HLHS新生儿和23例d-TGA新生儿。RRi指标的数据可得时间为110天。在未校正模型中，LF功率（估计值：-4.4×10，P = 0.02）、HF功率（-4.1×10，5×10）、RMS（-3.7×10，8.7×10）和RMS（-1.4×10，0.02）均与手术时间呈负相关，其中HF功率的相关性最强。校正协变量后，HF功率与时间仍保持显著负相关（-0.04，P = 0.03）。cCHD诊断对RRi指标无显著影响。
在患有cCHD的新生儿中，术前自主神经功能呈逐渐下降趋势。RRi指标可能是这些患者生理状态恶化的有价值指标。
