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Altered autonomic control in preterm newborns with impaired neurological outcomes

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Abstract

Purpose

Very preterm newborns are at high risk of neurological injury. The objective of this work was to study the impact of neurological aggression on the autonomic nervous system.

Methods

We studied polysomnography recordings, at term corrected gestational age, for 38 preterm infants born at less than 28 weeks or weighing less than 1 kg. These infants were seen by a neuropediatrician, average age at follow up was 54.4 months. We created two groups: one with children who did not have any neurological disorder, including cerebral palsy (CP), language or mental retardation, visual or hearing disability, and attention disorder; the second group contained children with at least one of these impairments. From the polysomnography recordings, using coarse-graining spectral analysis, we compared heart rate variability indices between preterm infants with normal and abnormal neurological outcomes.

Results

Twenty infants had an impaired neurological outcome. Regarding the clinical characteristics, there were more babies born from smoking mothers (p = 0.025), with early-onset neonatal sepsis (p = 0.04), and abnormal results on cerebral magnetic resonance imaging (p = 0.014) in the group with impaired neurological outcomes. Spectral parameters were significantly different between active and quiet sleep. Total powers, harmonic and non-harmonic powers, high frequency and low frequency powers were higher in active sleep compared with those in quiet sleep. Preterm babies with impaired neurological development, in particular those with CP, had lower total power and non-harmonic power especially in active sleep than those with normal neurological outcome.

Conclusion

These findings suggest that, in very preterm infants, perinatal neurological injuries could be associated with abnormal maturation of the autonomic nervous system.

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Abbreviations

GA:

Gestational age at birth

PCA:

Post-conceptional age

HRV:

Heart rate variability

LF:

Low frequency band of HRV (0–0.2 Hz)

HF:

High frequency band of HRV (0.2–2 Hz)

TP:

Total spectral power of HRV

HF/TP:

HF power normalized to the total spectral power

LF/TP:

LF power normalized to the total spectral power

SIDS:

Sudden infant death syndrome

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Conflict of interest

Patricia Franco had no conflict of interest for this work; she received payment for lectures by UCB (Xyrem, treatment for narcolepsy). The other authors declare no conflict of interest.

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Authors and Affiliations

  1. Pediatric Department, Centre Hospitalo-Universitaire de Besançon, Université de Franche-Comté, Besançon, France

    Gerard Thiriez & Clémence Mougey

  2. Department of Neonatology, Hôpital Erasme, ULB University, Brussels, Belgium

    Danièle Vermeylen

  3. Department of Neuropediatrics, Hôpital Erasme, ULB University, Brussels, Belgium

    Vanessa Wermenbol

  4. Sleep Department, Erasmus Hospital, ULB, Brussels, Belgium

    Jean-Pol Lanquart

  5. Integrative Physiology of Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, University Lyon 1, Lyon, France

    Jian Sheng Lin & Patricia Franco

  6. Pediatric Sleep Unit, Service Epilepsie, Sommeil, Explorations fonctionnelles Neuropédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, University Lyon 1, 59, Boulevard Pinel, 69500, Lyon, France

    Patricia Franco

Authors
  1. Gerard Thiriez
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  2. Clémence Mougey
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  3. Danièle Vermeylen
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  4. Vanessa Wermenbol
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  5. Jean-Pol Lanquart
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  6. Jian Sheng Lin
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  7. Patricia Franco
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Correspondence to Patricia Franco.

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Thiriez, G., Mougey, C., Vermeylen, D. et al. Altered autonomic control in preterm newborns with impaired neurological outcomes. Clin Auton Res 25, 233–242 (2015). https://doi.org/10.1007/s10286-015-0298-6

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  • DOI: https://doi.org/10.1007/s10286-015-0298-6

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