Heart rate characteristics and neurodevelopmental outcome in very low birth weight infants

被引:27
作者
Addison, K. [1 ]
Griffin, M. P. [2 ]
Moorman, J. R. [3 ,4 ]
Lake, D. E. [3 ,4 ,5 ]
O'Shea, T. M. [1 ]
机构
[1] Wake Forest Univ, Sch Med, Dept Pediat, Winston Salem, NC 27109 USA
[2] MedImmune, Gaithersburg, MD USA
[3] Univ Virginia, Dept Med, Div Cardiovasc, Charlottesville, VA USA
[4] Univ Virginia, Cardiovasc Res Ctr, Charlottesville, VA USA
[5] Univ Virginia, Dept Stat, Charlottesville, VA USA
关键词
cerebral palsy; developmental delay; very low birth weight; bayley scales of infant development; heart rate characteristics; heart rate variability; WHITE-MATTER INJURY; CEREBRAL-PALSY; CRANIAL ULTRASOUND; NEONATAL SEPSIS; MAGNETIC-RESONANCE; GESTATIONAL-AGE; BRAIN-DAMAGE; PREDICTION; TRENDS; TESTS;
D O I
10.1038/jp.2009.81
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Background: Sepsis in very low birth weight (VLBW) infants has been associated with an increased risk of adverse developmental outcome. We have identified abnormal heart rate characteristics (HRCs) that are predictive of impending sepsis, and we have developed a summary measure of an infant's abnormal HRCs during the neonatal hospitalization that we refer to as the cumulative HRC score (cHRC). Objective: In this study, we tested the hypothesis that increasing cHRC is associated with an increasing risk of adverse neurodevelopmental outcome in VLBW infants. Method: Data were collected on 65 VLBW infants whose HRCs were monitored while in the neonatal intensive care unit and who were examined at 12 to 18 months adjusted age. Using the Bayley Scale of Infant Development-II, we identified delays in early cognitive function (i.e., Mental Developmental Index <70) and psychomotor development (i.e., Psychomotor Developmental Index <70). Cerebral palsy (CP) was diagnosed using a standard neurological examination. Result: Increasing cHRC score was associated with an increased risk of CP (odds ratio per 1 standard deviation increase in cHRC: 2.6, 95% confidence limits: 1.42, 5.1) and delayed early cognitive development [odds ratio: 2.3 (1.3; 4.3)]. These associations remain statistically significant when adjusted for major cranial ultrasound abnormality. There was an association of increasing cHRC and delayed psychomotor development, which did not reach statistical significance [odds ratio: 1.7 (1.0, 3.0)]. Conclusion: Among VLBW infants, the cumulative frequency of abnormal HRCs, which can be assessed non-invasively in the neonatal intensive care unit, is associated with an increased risk of adverse neurodevelopmental outcome. Journal of Perinatology (2009) 29, 750-756; doi:10.1038/jp.2009.81; published online 25 June 2009
引用
收藏
页码:750 / 756
页数:7
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