In a cohort of neonates with transposition of the great arteries, 58 patients had neurodevelopmental outcomes assessed at 1 and 5 years of age following pre-discharge heart rate variability monitoring.
Cohort (n=90)
Does neonatal pre-discharge heart rate variability predict neurodevelopmental outcomes at 1 and 5 years in infants with transposition of the great arteries?
Neonatal pre-discharge heart rate variability is not a reliable independent predictor of neurodevelopmental outcomes at 1 or 5 years in children with transposition of the great arteries.
Children with congenital heart disease (CHD) are at increased risk for long-term neurodevelopmental impairment, yet reliable pre-discharge biomarkers are lacking. Heart rate variability (HRV), a non-invasive measure of autonomic regulation, has been proposed as a potential predictor. In This retrospective cohort study (2015–2024), 58 infants with transposition of the great arteries (TGA) who underwent 24-h Holter electrocardiogram (ECG) before discharge. HRV time domain metrics were calculated by segmented 10 min epochs and summarized and neurodevelopment assessed at 1 year ( n = 55) and at 5 years ( n = 21). Were analyzed using Pearson correlations and multivariable linear regression adjusting for cardiopulmonary bypass (CPB) time, postnatal age at ECG, socioeconomic status, and hospital stay. Neonatal HRV was not independently associated with cognitive, language, or motor outcomes at either follow up. Exploratory bivariate analyses showed a weak, non-significant negative correlation between vagally mediated HRV and visual motor integration at 5 years. Longer CPB time and lower socioeconomic status were independent predictors of poorer neurodevelopment. Neonatal pre-discharge HRV is not a reliable predictor for neurodevelopment at 1 or 5 years in children with TGA, highlighting the importance of perioperative complexity and socioeconomic factors. Multimodal longitudinal assessments are needed to better understand brain heart interaction in CHD. First study to longitudinally assess associations between neonatal HRV and neurodevelopmental outcomes at 1 and 5 years in children with TGA. Neonatal pre-discharge HRV is not independently associated with later developmental outcomes at 1 and 5 years in children with TGA. Single pre discharge HRV measurements should be interpreted cautiously, longitudinal and multimodal assessments are likely needed to identify neurodevelopmental risk in CHD.
Somasundaram et al. (2026) conducted a cohort in Transposition of the great arteries (n=90). Pre-discharge heart rate variability (24h-Holter ECG) was evaluated on Neurodevelopmental outcomes at 1 and 5 years. In a cohort of neonates with transposition of the great arteries, 58 patients had neurodevelopmental outcomes assessed at 1 and 5 years of age following pre-discharge heart rate variability monitoring.