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Am J Perinatol 2017; 34(09): 874-878
DOI: 10.1055/s-0037-1600127
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

The Impact of Surgical Patent Ductus Arteriosus Closure on Autonomic Function in Premature Infants

Nickie N. Andescavage
1   Division of Neonatology, Children's National Health System, Washington, District of Columbia
2   Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia
,
Marina Metzler
3   Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia
,
Vedavalli Govindan
3   Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia
,
Tareq Al-Shargabi
3   Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia
,
Dilip S. Nath
4   Division of Cardiovascular Surgery, Children's National Health System, Washington, District of Columbia
,
Anita Krishnan
2   Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia
5   Division of Cardiology, Children's National Health System, Washington, District of Columbia
,
An Massaro
1   Division of Neonatology, Children's National Health System, Washington, District of Columbia
2   Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia
,
Yunfei Wang
2   Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia
6   Division of Biostatistics and Study Methodology, Children's National Health System, Washington, District of Columbia
,
Adre J. duPlessis
2   Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia
3   Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia
,
R. B. Govindan
3   Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia
› Author Affiliations
Further Information

Publication History

14 October 2016

03 February 2017

Publication Date:
10 March 2017 (online)

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Abstract

Background Patent ductus arteriosus (PDA) is a common complication of prematurity and a risk factor for poor outcome. Infants undergoing surgical PDA ligation are at highest risk for neurodevelopmental injury. Autonomic dysfunction has been described in premature infants with PDA.

Aim To interrogate the autonomic nervous system by analysis of advanced heart rate variability (HRV) metrics before and after surgical closure of the PDA.

Study Design Prospective, observational study.

Subjects Twenty-seven infants born before 28 weeks' gestation were included in this study.

Methods Continuous electrocardiogram data were sampled at a rate of 125 Hz for a total of 6 hours before and 6 hours after 30 hours of surgical closure. HRV was determined by detrended fluctuation analysis to calculate the short and long root mean square (RMSL and RMSS) and α components at two time scales (long and short).

Results Gestational age (GA) was positively associated with RMSL, RMSS, and αS and was negatively associated with αL. There was no difference between RMSs, RMSL, αS, or αL before and after surgery; however, median heart rate was lower after surgery (p < 0.01).

Conclusion Advancing GA is highly associated with increasing HRV; however, surgical ligation does not affect HRV in the postoperative period.

Keywords

heart rate variability - patent ductus arteriosus - surgical closure - premature infants
 

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