Trajectories of Parasympathetic Nervous System Function Before, During, and After Feeding in Infants With Transposition of the Great Arteries

Abstract

Compromised parasympathetic response to stressors may underlie feeding difficulties in infants with complex congenital heart defects, but little is known about the temporal pattern of parasympathetic response across phases of feeding. The aim of this study was to describe initial data exploration of trajectories of parasympathetic response to feeding in 15 infants with surgically corrected transposition of the great arteries and to explore the effects of feeding method, feeding skill, and maternal sensitivity on trajectories. In this descriptive, exploratory study, parasympathetic function was measured using high-frequency heart rate variability (HF HRV), feeding skill was measured using the Early Feeding Skills assessment, and maternal sensitivity was measured using the Parent-Child Early Relational Assessment. Data were collected before, during, and after feeding at 2 weeks and 2 months of age. Trajectories of parasympathetic function and relationships with possible contributing factors were examined graphically. Marked between-infant variability in HF HRV across phases of feeding was apparent at both ages, although it was attenuated at 2 months. Four patterns of HF HRV trajectories across phases of feeding were identified and associated with feeding method, feeding skill, and maternal sensitivity. Developmental increases in HF HRV were apparent in most breast-fed, but not bottle-fed, infants. This exploratory data analysis provides critical information in preparation for a larger study in which varying trajectories and potential contributing factors can be modeled in relationship to infant outcomes. Findings support inclusion of feeding method, feeding skill, and maternal sensitivity in modeling parasympathetic function across feeding.