Vagal Responsiveness to Gavage Feeding as an Index of Preterm Status

ABSTRACT: Vagal responsivity to orogastric stimulation is necessary for gastrointestinal function and may reflect antonomic regulation. Our study evaluated vagal responsivity during gavage feeding as an index of preterm clinical status. Vagal and behavioral responsivity of 26 preterm infants during gavage feeding was measured. Vagal tone was quantified with a noninvasive measure (vagal tone index) developed by Porges (Porges SW: U.S. patent 4 510 944, 1985), which extracts a valid measure of cardiac vagal tone from the ECG. The study investigated whether vagal tone changed during gavage feeding and whether individual differences in the vagal tone response pattern were related to clinical outcome. Infants who demonstrated an increase in vagal tone during feeding and a decrease after feeding had significantly shorter hospitalizations. This effect was independent of weight gain trajectories. Baseline levels of vagal tone were positively associated with subsequent weight gain. Traditional risk measures did not predict length of hospitalization independently of gestational age. This study represents the first documentation that small changes in cardiac vagal tone during gavage feeding, previously imperceptible to clinicians and researchers, may be quantitatively extracted from the ECG and provide an important index of clinical status.

[1]  S. Porges,et al.  Newborn pain cries and vagal tone: parallel changes in response to circumcision. , 1988, Child development.

[2]  L M Dubowitz,et al.  Clinical assessment of gestational age in the newborn infant. , 1970, The Journal of pediatrics.

[3]  A. Fanaroff,et al.  Current concepts: the low-birth-weight infant--evolution of a changing outlook. , 1979, The New England journal of medicine.

[4]  L. Becker,et al.  Myelination of the Human Vagus Nerve from 24 Weeks Postconceptional Age to Adolescence , 1982, Journal of neuropathology and experimental neurology.

[5]  N. Fox,et al.  The relation between neonatal heart period patterns and developmental outcome. , 1985, Child development.

[6]  Feedback theory and its application to biological systems. , 1964, Symposia of the Society for Experimental Biology.

[7]  J. Cacioppo,et al.  Principles of psychophysiology : physical, social, and inferential elements , 1990 .

[8]  D. Strobino,et al.  Evaluation of a Measure of Neonatal Morbidity , 1984, Medical care.

[9]  Stephen W. Porges,et al.  Respiratory Sinus Arrhythmia: Physiological Basis, Quantitative Methods, and Clinical Implications , 1986 .

[10]  P. A. Davies,et al.  Low birth weight children at school age: neurological, psychological, and pulmonary function. , 1982, Seminars in perinatology.

[11]  C. Hobel,et al.  Prenatal and intrapartum high-risk screening. I. Prediction of the high-rish neonate. , 1973, American journal of obstetrics and gynecology.

[12]  N. Marlow,et al.  Neurodevelopmental outcome in babies weighing less than 2001 g at birth. , 1987, British medical journal.

[13]  A. H. Parmelee,et al.  Medical correlates of infant development. , 1978, Pediatrics.

[14]  Stephen W. Porges,et al.  Heart rate patterns in neonates: A potential diagnostic window to the brain , 1982 .

[15]  S. Porges,et al.  The analysis of periodic processes in psychophysiological research , 1989 .

[16]  A. Lilienfeld,et al.  A study of the association of factors of pregnancy and parturition with the development of cerebral palsy; a preliminary report. , 1952, American journal of hygiene.

[17]  L. Ploughman,et al.  Prolonged mechanical ventilation and intracranial hemorrhage: impact on developmental progress through 18 months in infants weighing 1,200 grams or less at birth. , 1987, Pediatrics.

[18]  M. Behnke,et al.  Effect of Nonnutritive Sucking On Behavioral State In Preterm Infants Before Feeding , 1988, Nursing research.

[19]  P G Katona,et al.  Cardiac vagal efferent activity and heart period in the carotid sinus reflex. , 1970, The American journal of physiology.

[20]  K. Uvnäs-Moberg.  Gastrointestinal Hormones in Mother and Infant , 1989, Acta paediatrica Scandinavica. Supplement.

[21]  T. Field,et al.  A first-year follow-up of high-risk infants: formulating a cumulative risk index. , 1978, Child development.

[22]  G. Little,et al.  Neonatal mortality risk for the eighties: the importance of birth weight/gestational age groups. , 1981, Pediatrics.

[23]  P G Katona,et al.  Respiratory sinus arrhythmia: noninvasive measure of parasympathetic cardiac control. , 1975, Journal of applied physiology.

[24]  M C McCormick,et al.  The contribution of low birth weight to infant mortality and childhood morbidity. , 1985, The New England journal of medicine.

[25]  R. Zindwer.  PREVENTION OF MENTAL DISORDERS IN CHILDREN , 1962 .