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Am J Perinatol 2018; 35(11): 1079-1086
DOI: 10.1055/s-0038-1639339
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Changes in Autonomic Tone in Premature Infants Developing Necrotizing Enterocolitis

Tareq Al-Shargabi
1   Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia
,
Daniel Reich
1   Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia
,
R. B. Govindan
1   Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia
,
Somya Shankar
1   Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia
,
Marina Metzler
1   Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia
,
Caitlin Cristante
1   Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia
,
Robert McCarter
2   Division of Biostatistics and Informatics, Children's National Health System, Washington, District of Columbia
,
Anthony D. Sandler
3   Division of General and Thoracic Surgery, Children's National Health System, Washington, District of Columbia
,
Mariam Said
4   Division of Neonatology, Children's National Health System, Washington, District of Columbia
,
Adre du Plessis
1   Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia
› Author Affiliations
Funding This study was supported by internal special purpose funds in the Division of Fetal and Transitional Medicine at Children's National Health System.
Further Information

Publication History

07 November 2017

12 February 2018

Publication Date:
02 April 2018 (online)

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Abstract

Background Necrotizing enterocolitis (NEC) is a complication of prematurity with a high mortality rate. Currently, there are no reliable biomarkers capable of identifying infants at risk for developing NEC. We sought to determine the autonomic nervous system antecedents of NEC in premature infants, using heart rate variability (HRV).

Materials and Methods HRV was quantified by retrieving archived electrocardiogram (EKG) data from 30 premature infants from 4 days prior, through 4 days after, the clinical NEC diagnosis. HRV metrics were compared with those on the diagnosis day using the receiver operating characteristic (ROC) analysis.

Results HRV metrics showed a depression of autonomic tone that preceded the clinical NEC diagnosis by 2 days, and which recovered to baseline by 2 days after diagnosis (area under the curve [AUC] < 0.7). The pattern of HRV change was significantly associated with the clinical severity of NEC (stage II vs. stage III).

Conclusion Our studies suggest that readily accessible metrics of autonomic depression might expedite the diagnosis of NEC and its severity in a clinically meaningful manner. Clearly, these studies need to be extended prospectively to determine the diagnostic utility of this approach.

Keywords

preemie - heart rate variability - autonomic nervous system - necrotizing enterocolitis