Autonomic nervous system activity in premature and full-term infants from theoretical term to 7 years

The premature population reaching theoretical term suffers from a major deficit in autonomic nervous system (ANS) activity, as can be seen from heart rate variability indices. Whether this autonomic function recovers in the long term is not yet established. Thus, we analyzed and compared ANS activity indices, at birth or at the time of the theoretical term, and at ages 2-3 and 6-7 years, in two populations: a group of 30 premature children and a reference group of 14 full-term age-matched newborns. Using Fourier Transform analysis, we studied 24-h ECG Holter recordings to establish heart rate variability indices: Ptot, VLF, LF, HF, ratio LF/HF, LFnu, HFnu. In the neonatal period, sympathetic and even more markedly, parasympathetic activities were very low in prematures compared to the reference full-term group. At ages 2-3 and 6-7 years, prematures had recovered and had similar ANS activity as the full-term group. These data suggest a fast ANS maturation in prematures during the two first years of life, with a higher speed of recovery for the parasympathetic arm. Furthermore, compared evolution shows a faster ANS maturation in premature. Potential mechanisms are discussed.

[1]  R. Feldman,et al.  Skin-to-skin contact (Kangaroo Care) accelerates autonomic and neurobehavioural maturation in preterm infants. , 2003, Developmental medicine and child neurology.

[2]  P. Colditz,et al.  Infant autonomic function is altered by maternal smoking during pregnancy. , 2000, Early human development.

[3]  S. Ludington-Hoe,et al.  Heart rate variability responses of a preterm infant to kangaroo care. , 2005, Journal of obstetric, gynecologic, and neonatal nursing : JOGNN.

[4]  L. Curzi-Dascalova.  Développement du sommeil et des fonctions sous contrôle du système nerveux autonome chez le nouveau-né prématuré et à terme , 1995 .

[5]  T. Schaible,et al.  Maturation of the autonomic nervous system: differences in heart rate variability in premature vs. term infants , 2006, Journal of perinatal medicine.

[6]  B. Taylor,et al.  Factors Affecting Heart Rate Variability and Heart Rate Responses to Tilting in Infants Aged 1 and 3 Months , 2000, Pediatric Research.

[7]  Heritability of heart rate variability: the Framingham Heart Study. , 1998 .

[8]  Lili Zhou,et al.  Sudden Infant Death Syndrome: Case-Control Frequency Differences at Genes Pertinent to Early Autonomic Nervous System Embryologic Development , 2004, Pediatric Research.

[9]  F Telliez,et al.  Body temperature regulation in the newborn infant: interaction with sleep and clinical implications , 1996, Neurophysiologie Clinique/Clinical Neurophysiology.

[10]  T. Schaible,et al.  Short term heart rate variability in healthy neonates: normative data and physiological observations. , 2005, Early human development.

[11]  N. Wells,et al.  Behaviors of Very Preterm Neonates as Documented Using NIDCAP Observations , 2001, Neonatal Network.

[12]  T. Tulassay,et al.  Adult cardiovascular risk factors in premature babies , 2000, The Lancet.

[13]  G. Breithardt,et al.  Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. , 1996 .

[14]  T. McIntosh,et al.  The Ile164 beta2-adrenergic receptor polymorphism adversely affects the outcome of congestive heart failure. , 1998, The Journal of clinical investigation.

[15]  D. Lonsdale.  Sudden infant death syndrome requires genetic predisposition, some form of stress and marginal malnutrition. , 2001, Medical hypotheses.

[16]  M. Eiselt,et al.  Sleep State Organization in Premature Infants of Less Than 35 Weeks' Gestational Age , 1993, Pediatric Research.

[17]  R L Andres,et al.  Perinatal complications associated with maternal tobacco use. , 2000, Seminars in neonatology : SN.

[18]  H. Kinney,et al.  Brainstem 3H-Nicotine Receptor Binding in the Sudden Infant Death Syndrome , 1998, Journal of neuropathology and experimental neurology.

[19]  W. Fifer,et al.  Sudden fetal and infant deaths: shared characteristics and distinctive features. , 2002, Seminars in perinatology.

[20]  L. Stegagno,et al.  Heart rate variability during sleep as a function of the sleep cycle , 2003, Biological Psychology.

[21]  J. Barthélémy,et al.  Birth prematurity determines prolonged autonomic nervous system immaturity , 2004, Clinical Autonomic Research.

[22]  U. Kesmodel,et al.  A prospective study of smoking during pregnancy and SIDS , 2000, Archives of disease in childhood.

[23]  Solange Akselrod,et al.  Development and Maturation of the Autonomic Nervous System in Premature and Full-Term Infants Using Spectral Analysis of Heart Rate Fluctuations , 1995, Pediatric Research.

[24]  W. Fifer,et al.  Maturational changes in heart rate and heart rate variability in low birth weight infants. , 2000, Developmental psychobiology.

[25]  W. Fifer,et al.  Developmental changes in infant heart rate responses to head-up tilting. , 2006, Acta paediatrica.

[26]  B. Dan,et al.  Sudden infant deaths: stress, arousal and SIDS. , 2003, Early human development.

[27]  S Cerutti,et al.  Power spectral analysis of the heart rate of the human fetus at 26 and 36 weeks of gestation. , 1989, Clinical physics and physiological measurement : an official journal of the Hospital Physicists' Association, Deutsche Gesellschaft fur Medizinische Physik and the European Federation of Organisations for Medical Physics.

[28]  Yuru Zhong,et al.  Quantifying cardiac sympathetic and parasympathetic nervous activities using principal dynamic modes analysis of heart rate variability. , 2006, American journal of physiology. Heart and circulatory physiology.

[29]  C. Bouchard,et al.  Heart rate recovery after maximal exercise is associated with acetylcholine receptor M2 (CHRM2) gene polymorphism. , 2006, American journal of physiology. Heart and circulatory physiology.

[30]  T. Moritani,et al.  Association of C825T polymorphism of G protein beta3 subunit with the autonomic nervous system in young healthy Japanese individuals. , 2005, American journal of hypertension.

[31]  A. Struthers,et al.  Sudden unexpected death in heart failure may be preceded by short term, intraindividual increases in inflammation and in autonomic dysfunction: a pilot study , 2004, Heart.

[32]  Jacques-Olivier Fortrat.  Inaccurate normal values of heart rate variability spectral analysis in newborn infants. , 2002, The American journal of cardiology.