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Autonomic cardiovascular control in hypotensive critically ill preterm infants is impaired during the first days of life.
MedLine Citation:
PMID:  23313567     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: The first days after preterm birth are a critical period of cardiovascular instability, where hypotension is common. We assessed autonomic cardiovascular function by measuring heart rate variability (HRV), blood pressure variability (BPV) and baroreflex sensitivity (BRS) and hypothesised that these would be impaired in preterm infants born at younger gestational ages. In addition, we speculated that impaired cardiovascular control could be used as a marker of circulatory failure such as is manifest as hypotension. METHODS: 23 preterm infants (11 M/12 F) born between 23 and 35weeks (mean 27±0.6weeks) gestational age with indwelling arterial catheters were recruited. Infants were studied over the first 3days of life with heart rate and blood pressure (BP) analysed beat to beat in the frequency domain in 2minute epochs of artefact free data during active sleep. Data were compared with one way ANOVA. RESULTS: Gestational age was correlated with all HRV indices but not BPV or BRS. 9 babies received inotropes. Gestational age between the inotrope group and the non-inotrope group was not different. BP and RR interval were lower in the inotrope group (40.7±1.5 vs 47.1±1.5mmHg, p<0.05 and 395±14 vs 426±11ms, p<0.08). BRS was also lower in the inotrope group (3.8±0.9 vs 6.9±1.6ms/mmHg) as was LF/HF HRV (5.7±1.3 vs 13.6±2.8, p<0.05). CONCLUSIONS: In the first 3days after birth, infants receiving inotropes had significantly impaired cardiovascular control compared to those who did not receive treatment, indicating that these infants maybe predisposed to increased vulnerability to circulatory instability.
Authors:
Vera Golder; Michele Hepponstall; Stephanie R Yiallourou; Alexsandria Odoi; Rosemary S C Horne
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-10
Journal Detail:
Title:  Early human development     Volume:  -     ISSN:  1872-6232     ISO Abbreviation:  Early Hum. Dev.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7708381     Medline TA:  Early Hum Dev     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier Ireland Ltd.
Affiliation:
The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, Victoria 3168, Australia.
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