Preoperative autonomic failure in neonates with critical congenital heart disease

Authors

R B. Govindan, 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.
Stefano Pezzato, Neonatal and Pediatric Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy; Division of Cardiac Surgery, Children's National Hospital, Washington, DC, USA.
Julius Ngwa, The Developing Brain Institute, Children's National Hospital, Washington, DC, USA.
Anita Krishnan, Department of Pediatrics, The George Washington University School of Medicine, Washington, DC, USA; Division of Cardiology, Children's National Hospital, Washington, DC, USA.
Eleni Panagopoulos, The Developing Brain Institute, Children's National Hospital, Washington, DC, USA.
Venkata Chaitanya Chirumamilla, The Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA; The Developing Brain Institute, Children's National Hospital, Washington, DC, USA.
Adre du Plessis, 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. Electronic address: adupless@childrensnational.org.

Document Type

Journal Article

Publication Date

11-24-2024

Journal

Early human development

Volume

200

DOI

10.1016/j.earlhumdev.2024.106165

Keywords

Autonomic dysfunction; Critical congenital heart disease; Heart rate variablity; Hypoplastic left heart syndrome; Preoperative monitoring

Abstract

BACKGROUND: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

APA Citation

Govindan, R B.; Pezzato, Stefano; Ngwa, Julius; Krishnan, Anita; Panagopoulos, Eleni; Chirumamilla, Venkata Chaitanya; and du Plessis, Adre, "Preoperative autonomic failure in neonates with critical congenital heart disease" (2024). GW Authored Works. Paper 5975.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5975

Department

Pediatrics