Abstract
Objective The present study is aimed at assessing heart rate variability (HRV) and its correlation with visual acuity (VA) assessment of preterm newborns (PTNB) in neonatal intensive care units. Method Cross-sectional study analyzing HRV during assessment of VA with the aid of a Polar RS800CX heart rate monitor (Polar Electro Oy, Finland). HRV was analyzed according to time and frequency domains and the chaos domain used the autocorrelation coefficient and entropy. The sample consisted of hospitalized PTNB, and static analysis included simple regression diagnosis. Results A total of 14 PTNB were included in the sample. VA varied between 0.23 and 1.60 cpd, and only five PTNB obtained below-expected values for age. Statistical analysis demonstrated a negative correlation between VA and time domain (SDDN and SD2) and a positive correlation between frequency domain (heart rate and hertz), but in simple linear regression analysis, these variables did not influence VA. Conclusion The results of the study demonstrate that visual acuity was inversely correlated with SDNN and SD2 and during stimulation, showing that the higher the visual performance, the lower the autonomic modulation response.
Highlights
Despite the need for a qualified professional to assess the vision of newborns in neonatal intensive care units, this does not occur in many Brazilian public hospitals and few studies compromising visual development and early preterm newborns (PTNB) rehabilitation [13, 14]
We can infer that assessing visual system maturity, using heart rate variability (HRV), is an innovative resource, which results in a clear advantage during execution, since it uses heartbeats as a physiological parameter of vagal parasympathetic fiber actions, determining deceleration and sympathetic fiber actions caused by acceleration, because changes in the sensory system of children can be represented by a decrease in the sympathetic system and by the impairment of the parasympathetic system [15]
A total of 25 PTNB were screened, 14 of whom were included in the sample, 11 were excluded for being in a deep sleep at the moment of collection (6) or scheduled for discharge before the researchers’ visit (5)
Summary
Autonomic modulation, estimated by heart rate variability (HRV) and regulated by sympathetic and parasympathetic pathways, has been increasingly used as a measure of term and preterm newborn stress and well-being [1,2,3].In addition to being considered a sensitive and useful tool to determine autonomic nervous system maturation [4], it clinically measures the ability to adapt to external events [5], maintain homeostasis [6], and conserve energy [7].Given the conditions in neonatal intensive care units, preterm newborns are more susceptible to behavioral changes caused by exposure to pain stimuli [8], excessive light and noise [9], and invasive procedures such as mechanical ventilation [10].When applied to preterm newborns (PTNB), these procedures favor the emergence of complications and comorbidities, including ischemic hypoxic encephalopathy [8], bronchopulmonary dysplasia [11], and visual sequelae such as retinopathy of prematurity [12].Despite the need for a qualified professional to assess the vision of newborns in neonatal intensive care units, this does not occur in many Brazilian public hospitals and few studies compromising visual development and early PTNB rehabilitation [13, 14].we can infer that assessing visual system maturity, using HRV, is an innovative resource, which results in a clear advantage during execution, since it uses heartbeats as a physiological parameter of vagal parasympathetic fiber actions, determining deceleration and sympathetic fiber actions caused by acceleration, because changes in the sensory system of children can be represented by a decrease in the sympathetic system and by the impairment of the parasympathetic system [15]. Given the conditions in neonatal intensive care units, preterm newborns are more susceptible to behavioral changes caused by exposure to pain stimuli [8], excessive light and noise [9], and invasive procedures such as mechanical ventilation [10]. Despite the need for a qualified professional to assess the vision of newborns in neonatal intensive care units, this does not occur in many Brazilian public hospitals and few studies compromising visual development and early PTNB rehabilitation [13, 14]. We can infer that assessing visual system maturity, using HRV, is an innovative resource, which results in a clear advantage during execution, since it uses heartbeats as a physiological parameter of vagal parasympathetic fiber actions, determining deceleration and sympathetic fiber actions caused by acceleration, because changes in the sensory system of children can be represented by a decrease in the sympathetic system and by the impairment of the parasympathetic system [15]
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