Agudelo-Pérez Sergio, Troncoso Gloria, Arenas Auli Alvaro, Ayala Camila
Department of Pediatrics, School of Medicine, Universidad de La Sabana, Chía 250001, Cundianamarca, Colombia.
Head Neonatal Unit, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá 110131, Colombia.
Medicina (Kaunas). 2025 Sep 9;61(9):1631. doi: 10.3390/medicina61091631.
: Neonates with moderate-to-severe hypoxic-ischemic encephalopathy (HIE) in low- and middle-income countries (LMICs) remain at high risk of neurological sequelae despite access to therapeutic hypothermia (TH). Real-time accessible biomarkers are required to improve risk stratification and guide neuroprotective care in these settings. This study evaluated the predictive capacity of heart rate variability (HRV) metrics for brain injury detected using magnetic resonance imaging (MRI) in neonates with HIE who underwent TH at an LMIC. : We conducted a prospective observational study of 87 neonates treated with TH in a tertiary neonatal intensive care unit in Colombia. HRV was recorded during the first 24 h of TH, during rewarming, and 24 h after rewarming. Brain MRI was performed within the first week of life and scored using the Rutherford system. Associations between HRV metrics and global and regional brain injuries were analyzed using receiver operating characteristic (ROC) curves and multivariable logistic regression models. : Low-frequency (LF) and high-frequency (HF) powers were significantly lower in neonates with MRI abnormalities. LF power during rewarming demonstrated the highest predictive accuracy (AUC = 0.90), followed by HF power during the first 24 h (AUC = 0.80). Region-specific analyses showed that LF power reduction was significantly associated with white matter and basal ganglia injury. : HRV, particularly LF power during rewarming, is a promising and accessible biomarker for regional brain injury in neonates with perinatal asphyxia treated with TH.
在低收入和中等收入国家（LMICs），患有中重度缺氧缺血性脑病（HIE）的新生儿尽管接受了治疗性低温（TH），但仍面临着较高的神经后遗症风险。在这些情况下，需要实时可获取的生物标志物来改善风险分层并指导神经保护护理。本研究评估了心率变异性（HRV）指标对在LMIC接受TH治疗的HIE新生儿中使用磁共振成像（MRI）检测到的脑损伤的预测能力。
我们在哥伦比亚一家三级新生儿重症监护病房对87例接受TH治疗的新生儿进行了一项前瞻性观察研究。在TH的前24小时、复温期间和复温后24小时记录HRV。在出生后第一周内进行脑部MRI检查，并使用卢瑟福系统进行评分。使用受试者工作特征（ROC）曲线和多变量逻辑回归模型分析HRV指标与全脑和局部脑损伤之间的关联。
MRI异常的新生儿的低频（LF）和高频（HF）功率显著降低。复温期间的LF功率显示出最高的预测准确性（AUC = 0.90），其次是前24小时的HF功率（AUC = 0.80）。区域特异性分析表明，LF功率降低与白质和基底神经节损伤显著相关。
HRV，尤其是复温期间的LF功率，是接受TH治疗的围产期窒息新生儿局部脑损伤的一种有前景且可获取的生物标志物。
