Abnormal heart rate variability at school age in survivors of neonatal hypoxic-ischemic encephalopathy managed with therapeutic hypothermia

Mood and anxiety spectrum disorders detected by neuropsychiatric interviews in young adults born preterm: A prospective cohort study

BACKGROUND

Psychopathology has not yet been studied beyond pediatric age for all degrees of prematurity, including late-preterm, particularly in those who grew up with no apparent neurodevelopmental sequelae. This study aimed to examine psychopathological outcome following preterm birth and admission to neonatal intensive care in young adults without major neurodevelopmental and psychopathological problems that emerged during childhood.

METHODS

An Italian single-center prospective cohort study. Eighty-nine young adults (40 admitted to neonatal intensive care unit with less than 37 weeks of gestation and no medical history of other neurological or psychiatric conditions in childhood and 49 healthy peers born at term, matched by age, sex, and education) underwent neuropsychiatric interviews at the age of 20 ± 1 years; MINI International Neuropsychiatric Interview, Beck Depression Inventory and Barratt Impulsive Scale, results were correlated to individual neonatal data and cognitive measures.

RESULTS

We found a significantly higher prevalence of psychopathology at MINI score (22.5% vs. 4.2%; χ2 = 6.7; p = 0,010) and prevalence of previous stressful life events in the preterm compared to at-term group. B.D.I. (testing depression) and BIS-11(testing impulsivity) did not highlight a statistically significant difference between the groups. All patients had average I.Q., a statistically significant difference (p < 0.001) was observed between groups with a better performance in controls than cases.

CONCLUSIONS

Preterm infants attaining young adult age with otherwise typical development during childhood are at risk of psychopathology and lower resilience to stressful life events. The MINI interview could be a useful tool to highlight the psychopathology of preterm infants attaining adult age.

Measuring effects of height on the autonomic nervous system in middle-aged adolescents using the very low frequency band of heart rate variability

Previous studies have revealed the association between falling accidents and stress, measured via heart rate variability (HRV). However, none have studied this association using the very low frequency (VLF) band of HRV in adolescent populations. This study aimed to fill this gap by recruiting 90 adolescents to perform a light physical task at varying heights. Heart rates were used to calculate short-term HRV. The results showed a positive correlation between VLF bands and parasympathetic indices and a negative correlation with sympathetic indices, demonstrating the balancing effects of the autonomic modulation associated with height. The lowest VLF bands were obtained as 79.25 ms² at 10 m (p < 0.001) and 62.87 ms² at 9 m (p < 0.001) for the experienced and non-experienced male groups, respectively, and 28.09 ms² at 6 m (p = 0.001) for the female group. The results also suggested the need for a relatively lower height restriction for female adolescents than for males.Practitioner summary: Increased working heights can cause stress, which leads to falling accidents. The very low frequency band was shown to be associated with parasympathetic and sympathetic indices. Furthermore, the results suggested that the height limit necessary for providing a safe working environment may be lower for female adolescents than for males.Abbreviations: HRV: heart rate variability; VLF: very low frequency; ms2: absolute power; ANS: autonomic nervous system; PNS: parasympathetic nervous system; SNS: sympathetic nervous system; RR: intervals between two successive peaks of R waves; RMSSD: root mean square of successive RR interval differences; SD1: Poincaré plot index of standard deviation 1; SD2: Poincaré plot index of standard deviation 2; HF: high frequency; LF: low frequency; BMI: body mass index; ECG: electrocardiography; HR: heart rate; FFT: fast Fourier transformation; IQR: interquartile range; r: non-parametric partial correlation coefficient; η2: eta-squared; EM: experienced males; NM: non-experienced males; NF: non-experienced females; EEG: electroencephalogram.

Optimal neuromonitoring techniques in neonates with hypoxic ischemic encephalopathy

Neonates with hypoxic ischemic encephalopathy (HIE) are at significant risk for adverse outcomes including death and neurodevelopmental impairment. Neuromonitoring provides critical diagnostic and prognostic information for these infants. Modalities providing continuous monitoring include continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), near-infrared spectroscopy (NIRS), and heart rate variability. Serial bedside neuromonitoring techniques include cranial ultrasound and somatic and visual evoked potentials but may be limited by discrete time points of assessment. EEG, aEEG, and NIRS provide distinct and complementary information about cerebral function and oxygen utilization. Integrated use of these neuromonitoring modalities in addition to other potential techniques such as heart rate variability may best predict imaging outcomes and longer-term neurodevelopment. This review examines available bedside neuromonitoring techniques for the neonate with HIE in the context of therapeutic hypothermia.

Social skills and psychopathology are associated with autonomic function in children: a cross-sectional observational study

In recent years, the increase of psychopathological disorders in the population has become a health emergency, leading to a great effort to understand psychological vulnerability mechanisms. In this scenario, the role of the autonomic nervous system (ANS) has become increasingly important. This study investigated the association between ANS, social skills, and psychopathological functioning in children. As an ANS status proxy, we measured heart rate variability (HRV). Infants admitted to the neonatal intensive care unit of the University Hospital of Padova because of preterm birth or neonatal hypoxic-ischemic encephalopathy were sequentially recruited from January 2011 to June 2013 and followed long-term up to school age in this cross-sectional observational study. We recorded 5 minutes of HRV immediately before measuring performance in social abilities tasks (affect recognition and theory of mind, NEPSY-II) in 50 children (mean age 7.4 ± 1.4 years) with and without risk factors for developing neuropsychiatric disorders due to pre-/perinatal insults without major sequelae. Children also completed extensive cognitive, neuropsychological, and psychosocial assessment. Parents were assessed with psychopathological interviews and a questionnaire (CBCL 6-18). Analysis in a robust Bayesian framework was used to unearth dependencies between HRV, social skills, and psychopathological functioning. Social task scores were associated with HRV components, with high frequency the most consistent. HRV bands were also associated with the psychopathological questionnaire. Only normalized HRV high frequency was able to distinguish impaired children in the affect recognition task. Our data suggest that ANS may be implicated in social cognition both in typical and atypical developmental conditions and that HRV has cross-disease sensitivity. We suggest that HRV parameters may reflect a neurobiological vulnerability to psychopathology. The study was approved by the Ethics Committee of the University Hospital of Padova (Comitato Etico per la Sperimentazione, Azienda Opedaliera di Padova, approval No. 1693P).

Effects of early intake of amino acid on the neurodevelopmental outcomes in very low birth weight infants at correct age of 20 months and school age

BACKGROUND

Inadequate nutrition leads to poor neurodevelopmental outcomes in very low-birth weight infants (VLBWIs). This study aimed to investigate the beneficial effects of early amino acid intake on the neurodevelopmental outcomes in VLBWIs at 20 months of correct age and school age.

METHODS

The information of VLBWIs that received amino acid intake were retrospectively analyzed in this study. The cases in early group (EAA) received amino acid within 24 h, but the cases in standard group (SAA) after 48 h post-natal. The body weight, height, and Bayley score of the infants at correct age of 20 months were compared between groups. And the cognitive outcomes at school age were evaluated using Wechsler Intelligence Scale and Das-Naglieri cognitive assessment system.

RESULTS

There were no differences at baseline characteristics of the VLBWIs between EAA and SAA groups. Compared with the SAA group, the infants in EAA group had shorter time to regain birth weight (P < 0.05). The head circumference, MDI, and PDI in EAA group at 20 months of correct age were significantly higher than that in SAA group (both P < 0.05). According to the Wechsler scale and Das-Naglieri scores, the infants in EAA group had markedly improved cognitive outcomes compared with those in SAA group (all P < 0.05).

CONCLUSION

The results of this study revealed that early amino acid intake within 24 h could significantly improve the neurodevelopmental and cognitive outcomes in VLBWIs at 20 months of correct age and school age.