Effect of Temperature on Heart Rate Variability in Neonatal ICU Patients With Hypoxic-Ischemic Encephalopathy

Q: What are the key findings of this study?

Increasing temperature during rewarming after therapeutic hypothermia was associated with an overall decrease in heart rate variability in neonates with hypoxic-ischemic encephalopathy (p<0.01).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: moderate to severe hypoxic-ischemic encephalopathy (n=44). Intervention: Changes in temperature during rewarming. Primary outcome: Relationship between measures of heart rate variability and esophageal/axillary temperatures (p=<0.01).

Q: What does this research mean for the field?

Increasing core body temperature during rewarming after therapeutic hypothermia is associated with an overall decrease in heart rate variability in neonates with hypoxic-ischemic encephalopathy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate whether heart rate variability metrics correlate with body temperature changes during rewarming after therapeutic hypothermia in neonates with hypoxic-ischemic encephalopathy.

An N. Massaro; Heather E. Campbell; Marina Metzler; Tareq Al‐Shargabi; Yunfei Wang; Adré du Plessis; Rathinaswamy B. Govindan

doi:10.1097/pcc.0000000000001094

February 15, 2017Pediatric Critical Care MedicineOpen Access

Effect of Temperature on Heart Rate Variability in Neonatal ICU Patients With Hypoxic-Ischemic Encephalopathy

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Key result

Rising temperature during hypothermia rewarming is linked to decreased HRV in neonates with HIE.

P<0.01
n=44

Why the study?

Does temperature change during rewarming affect heart rate variability in infants with hypoxic-ischemic encephalopathy?

Key Points

To evaluate whether heart rate variability metrics correlate with body temperature changes during rewarming after therapeutic hypothermia in neonates with hypoxic-ischemic encephalopathy.
Conducted a prospective observational study in a Level 4 neonatal intensive care unit involving 44 infants with moderate-to-severe hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia.
Analyzed continuous electrocardiogram recordings from 2 hours prior to rewarming through 2 hours post-rewarming (up to 10 hours) alongside esophageal or axillary temperature recordings to measure beat-to-beat intervals, relative spectral power, and detrended fluctuation analysis exponents.
Low-frequency relative spectral power, short-term detrended fluctuation exponent (αS), and root mean square short and long time scales were negatively associated with temperature (p < 0.01).
Long-term detrended fluctuation exponent (αL) was positively associated with temperature (p < 0.01), reflecting an overall reduction in heart rate variability as infants warmed toward normothermia.

Study Design

Type

Observational (n=44)

Multicenter

No

Structured PICO

Does temperature change during rewarming affect heart rate variability in infants with hypoxic-ischemic encephalopathy?

P

Population

44 infants with moderate to severe hypoxic-ischemic encephalopathy treated with therapeutic hypothermia, monitored from 2 hours prior to rewarming through 2 hours after completion.

E

Exposure

Rewarming after therapeutic hypothermia (continuous ECG monitoring from 2 hours prior to rewarming through 2 hours after completion, up to 10 hr)

O

Outcome

Relationship between heart rate variability measures (beat-to-beat interval SD, low and high frequency relative spectral power, detrended fluctuation analysis short and long α exponents, and root mean square short and long time scales) and esophageal/axillary temperaturessurrogate

Main Result

p-value: p=<0.01

Heart rate variability decreases as temperature increases toward normothermia during rewarming in infants with hypoxic-ischemic encephalopathy, indicating temperature must be accounted for when using HRV as a biomarker.

Implication

HRV-temperature associations during HIE rewarming may require adjustment in biomarker analyses; leaves open independent prognostic value.

Discussion

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Cite This Study

Massaro et al. (2017) conducted an observational in moderate to severe hypoxic-ischemic encephalopathy (n=44). Changes in temperature during rewarming was evaluated on Relationship between measures of heart rate variability and esophageal/axillary temperatures (p=<0.01). Increasing temperature during rewarming after therapeutic hypothermia was associated with an overall decrease in heart rate variability in neonates with hypoxic-ischemic encephalopathy (p<0.01).

synapsesocial.com/papers/6aa4de44de97ea77ee81170d https://doi.org/10.1097/pcc.0000000000001094

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Effect of Temperature on Heart Rate Variability in Neonatal ICU Patients With Hypoxic-Ischemic Encephalopathy

Key Points

Study Design

Structured PICO

Main Result

Implication

Discussion

Cite This Study

Effect of Temperature on Heart Rate Variability in Neonatal ICU Patients With Hypoxic-Ischemic Encephalopathy

Key Points

Study Design

Structured PICO

Main Result

Implication

Discussion

Cite This Study

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