Autonomic Dysfunction in Neonates with Hypoxic Ischemic Encephalopathy Undergoing Therapeutic Hypothermia Impairs Physiological Responses to Routine Care Events.
Autonomic Dysfunction in Neonates with Hypoxic Ischemic Encephalopathy Undergoing Therapeutic Hypothermia Impairs Physiological Responses to Routine Care Events.
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DOI：
10.1016/j.jpeds.2017.12.071
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发表时间：
2018-05
期刊：
影响因子：
--
通讯作者：
Massaro AN
中科院分区：
文献类型：
--
作者：
Campbell H;Govindan RB;Kota S;Al-Shargabi T;Metzler M;Andescavage N;Chang T;Vezina G;du Plessis A;Massaro AN
评估新生儿重症监护室（NICU）护理期间，有自主神经功能障碍证据的新生儿缺氧缺血性脑病（HIE）患儿是否出现异常生理反应，从而导致脑损伤的进展。连续描记的心率（HR），血压（BP），脑近红外光谱（NIRS），和视频脑电图数据记录从hypotherapy治疗新生儿缺氧缺血性脑病。审查了16-24小时之间的视频，以确定不同的护理事件：（1）换尿布（DC）;（2）瞳孔检查（PE）;（3）气管插管操作（ET）;（4）疼痛程序（PP）。事件前心率变异性（HRV）用于将患者分为自主神经系统（ANS）功能受损组和完整组。采用最接近平均值分类法比较各组的事件后生理反应。对25例新生儿缺氧缺血性脑病99例临床资料进行分析。完整组在刺激事件（DC和PP）后HR/BP增加，而受损组HR/BP无变化或降低。在迷走神经刺激（PE和ET）下，完整组显示出预期的HR轻度降低，而受损组显示出HR的最小变化。此外，完整组的BP在PE后保持稳定/升高，而受损组的BP降低。在受损组中，DC后NIRS测量值增加，但在完整组中保持稳定或减少。HRV指标识别出ANS功能受损的婴儿对NICU护理事件的适应不良反应的风险。这些数据支持HRV作为能够指导高危新生儿神经保护护理的实时连续生理生物标志物。
To evaluate whether infants with HIE and evidence of autonomic dysfunction have aberrant physiological responses during NICU care events which could contribute to evolving brain injury. Continuous tracings of heart rate (HR), blood pressure (BP), cerebral near infrared spectroscopy (NIRS), and video EEG data were recorded from hypothermia-treated newborns with HIE. Videos between 16–24 hours of life were reviewed to identify distinct care events: (1) diaper changes (DC); (2) pupil exams (PE); (3) endotracheal tube manipulation (ET); (4) painful procedures (PP). Pre-event heart rate variability (HRV) was used to stratify patients into groups with Impaired versus Intact autonomic nervous system (ANS) function. Post-event physiological responses were compared between groups with nearest mean classification approach. Data from 99 clinical events in 25 newborns with HIE were analyzed. The Intact Group showed increased HR/BP after stimulating events (DC and PP), while the Impaired Group showed no change or decreased HR/BP. With vagal stimuli (PE and ET), the Intact Group demonstrated the expected mild decrease in HR while the Impaired Group showed minimal change in HR. Additionally, BP in the Intact group remained stable/increased whereas BP decreased in the Impaired group after PE. NIRS measures increased after DC in the Impaired group but remained stable or decreased in the Intact group. HRV metrics identify infants with impaired ANS function at risk for maladaptive responses to NICU care events. These data support HRV as a real-time continuous physiological biomarker capable of guiding neuroprotective care of high risk newborns.
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