Heart Rate In Preterm Infants Research Articles

Preterm Infant's Heart Rate Variability Near Birth Predicts Autonomic Symptoms at Age 3 to 5 Years.

Aims To describe the autonomic function of premature infants born between 28 and 32 weeks of gestation, without medical risk factors, at the age of 3 to 5 years and to assess whether it's possible to predict the appearance of autonomic deficits in these children at this age range. Methods This follow-up study included 40 out of 55 premature infants born between weeks 28 and 32 during 2018 to 2020. During 2022 to 2023 parents were asked to report on medical and developmental follow-up and treatment, functional characteristics of the autonomic system, and the age at which walking was achieved. Results Approximately 27% of the participants (11 out of 40) presented autonomic symptoms at 3 to 5 years of age. A predictive relationship was noted between the function of the heart rate control system near birth and the presence of autonomic dysfunctions at ages 3 to 5. Fourteen of 40 children received neurodevelopmental treatments. However, children with autonomic symptoms were not treated for their symptoms. Conclusion These preliminary findings provide valuable insights into the autonomic function of children born premature and the potential predictive relationship between early autonomic measures and later autonomic dysfunctions. It also highlights the need for increased awareness and intervention strategies for addressing autonomic issues in premature infants to support their overall well-being.

Effects of recorded maternal voice on anthropometric parameters and heart rate in premature infants: A pilot randomised controlled trial

PurposeTo explore the benefits of a recorded maternal voice intervention on weight, recumbent length, head circumference, and heart rate of preterm infants in the neonatal intensive care unit. MethodsA pilot randomised controlled trial was conducted in this study. Preterm infants in the neonatal intensive care unit (N = 109) were recruited and randomly assigned to an intervention or control group. Both groups received routine nursing care, while preterm infants in the intervention group received a recorded maternal voice program of 20 min, twice daily for 21 days. Preterm infants' daily weight, recumbent length, head circumference, and heart rate were collected during the 21-day intervention. Participants' heart rate in the intervention group was also recorded once a day pre-during-after the recorded maternal voice program. ResultsPreterm infants in the intervention group showed a significant increase in weight (−75.94, 95% CI −108.04, −43.85, P < 0.001), recumbent length (−0.54, 95% CI −0.76, −0.32, P < 0.001), and head circumference (−0.37, 95%CI −0.56, −0.18, P < 0.001) compared with the control group. Preterm infants in the intervention group also showed significant changes in heart rate pre-during-after the recorded maternal voice program. However, no significant differences were found in the heart rate scores between the two groups. DiscussionThe changes in heart rate pre-during-after the intervention may help explain participants' more significant increase in weight, recumbent length, and head circumference. Practice implicationsThe recorded maternal voice intervention could be incorporated into clinical practice to promote growth and development in preterm infants in the neonatal intensive care unit.Study registration: Australian New Zealand Clinical Trials Register, https://www.anzctr.org.au/; (registration number: ACTRN12622000019707).

Effect of initial and subsequent mask applications on breathing and heart rate in preterm infants at birth

ObjectiveApplication of a face mask may provoke the trigeminocardiac reflex, leading to apnoea and bradycardia. This study investigates whether re-application of a face mask in preterm infants at birth alters...

Preterm infant heart rate is lowered after Family Nurture Intervention in the NICU: Evidence in support of autonomic conditioning

BackgroundCardiac complications after premature birth are associated with negative long-term consequences to health. The Family Nurture Intervention (FNI) has been designed to support mother-infant parasympathetic calming sessions in the neonatal intensive care unit (NICU). FNI has shown neurodevelopmental and autonomic benefit across infant development. AimsWe tested the hypothesis that heart rate (HR) will decrease after FNI over the course of the NICU stay, compared to matched controls. Study designWe used a case-matched design. The intervention included on average four ~1-hour facilitated mother-infant ‘calming’ sessions per week. We collected 24/7 real time heart rate data from a central monitoring system and analyzed data from two time-periods. SubjectsThe intervention group comprised 37 infants born ~30 weeks gestational age (GA) in a level IV NICU, treated with FNI. From the same NICU and time-period, we created a contemporaneous comparison group of 32 infants who were case-matched to each intervention infant for sex, age-at-birth, singleton or twin status, month of admission and length of stay. Outcome measuresUsing generalized estimating equation (GEE) modeling, we analyzed 24/7 HR data during a 1-hour period between 4:30 and 5:30 am each day in the NICU, when all infants were least disturbed. Using repeated measures ANOVA, we analyzed 24/7 HR data during a 6-week period starting 1 week prior to the start of FNI and ending 5 weeks after start. ResultsGEE modeling of the 1-hour data from all subjects showed significant lower HR in the FNI group, compared with controls. ANOVA modeling on a subset of subjects over the five-week period showed that FNI infant HR decreased in a dose-response manner relative to SC HR. ConclusionThis study suggests FNI may condition lower infant HR in a dose-response manner during the NICU stay.

Effect of music therapy on preterm infants in neonatal intensive care unit: Systematic review and meta-analysis of randomized controlled trials.

To systematically examine the effectiveness of music therapy on preterm infants in neonatal intensive care unit. In recent years, the application of music therapy for preterm infants in neonatal intensive care unit has attracted more and more attention because of its clinical effects. However, there still exist disputes among different studies. A systematic review and meta-analysis. Eleven databases were searched over the period from 1910 -4 November 2019. Papers were selected for analysis in accordance with the PRISMA guidelines. The meta-analysis was carried out by using Review Manager 5.3 software. A total of 13 trials involving 1,093 participants were included. Meta-analysis showed music therapy had a significant influence on preterm infant's heart rate, respiratory rate, oral feeding volume, stress level, and maternal anxiety with moderate-to-high heterogeneity among studies. Also, music therapy had no influences on oxygen saturation and behavioural state. Music therapy can not only effectively improve preterm infant's heart rate, stable respiratory rate, and attenuate stress level but also exert positive impact on oral feeding volume. In addition, music therapy also plays a role in reducing maternal anxiety. However, due to the heterogeneity across studies in some outcomes, further studies with larger sample size and more stringent design should be conducted before recommendation. Music therapy can significantly improve preterm infant's heart rate, respiratory rate, and stress level, as well as increase oral feeding volume. These results may exert a positive impact on well-being and quality of life in preterm infants in the neonatal intensive care unit. Hospitals can apply music therapy which has been considered a non-pharmacological and no-invasive treatment to preterm infants in the neonatal intensive care unit.

Comparing the effect of two different interfaces on breathing of preterm infants at birth: A matched-pairs analysis

ObjectiveApplying a face mask could provoke a trigeminocardiac reflex. We compared the effect of applying bi-nasal prongs with a face mask on breathing and heart rate of preterm infants at birth. MethodsIn a retrospective matched-pairs study of infants <32 weeks of gestation, the use of bi-nasal prongs for respiratory support at birth was compared to the use of a face mask. Infants who were initially breathing at birth and subsequently received respiratory support were matched for gestational age (±4 days), birth weight (±300 g), general anaesthesia and gender. Breathing, heart rate and other parameters were collected before and after interface application and in the first 5 min thereafter. ResultsIn total, 130 infants were included (n = 65 bi-nasal prongs, n = 65 face mask) with a median (IQR) gestational age of 27+2 (25+3–28+4) vs 26+6 (25+3–28+5) weeks. The proportion of infants who stopped breathing after applying the interface was not different between the groups (bi-nasal prongs 43/65 (66%) vs face mask 46/65 (71%), p = 0.70). Positive pressure ventilation was given more often when bi-nasal prongs were used (55/65 (85%) vs 40/65 (62%), p < 0.001). Heart rate (101 (75–145) vs 110 (68–149) bpm, p = 0.496) and oxygen saturation (59% (48–87) vs 56% (35–84), p = 0.178) were similar in the first 5 min after an interface was applied in the infants who stopped breathing. ConclusionApnoea and bradycardia occurred often after applying either bi-nasal prongs or a face mask on the face for respiratory support in preterm infants at birth.

The effect of a face mask for respiratory support on breathing in preterm infants at birth

ObjectiveApplying a mask on the face for respiratory support could induce a trigeminocardiac reflex leading to apnoea and bradycardia. We have examined the effect of applying a face mask on breathing and heart rate in preterm infants at birth. MethodsResuscitation videos of infants ≤ 32 weeks gestation recorded from 2010 until 2018 at the Leiden University Medical Centre and the General University Hospital in Prague were reviewed. All infants received respiratory support via face mask. Breathing and heart rate were noted before and after application of the face mask and over the first 5 min. ResultsRecordings of 429 infants were included (median (IQR) gestational age of 28+6 (27+1-30+4) weeks). In 368/429 (86%) infants breathing was observed before application of the face mask and 197/368 (54%) of these infants stopped breathing following application of the face mask. Apnoea occurred at a median of 5 (3–17) seconds after application of the face mask with a duration of 28 (22–34) seconds of the first minute. In a logistic regression model, the occurrence of apnoea after face mask application was inversely associated with gestational age (OR = 1.424 (1.281–1.583), p < 0.001). Infants who stopped breathing had a significantly lower heart rate 82 (66–123) vs 134 (97–151) bpm, p < 0.001) and oxygen saturation (49% (33–59) vs 66% (50–82), p < 0.001) over the first minute after face mask application, compared to infants who continued breathing. ConclusionApplying a face mask for respiratory support affects breathing in a large proportion (54%) of preterm infants and this effect is gestational age dependent.

The effect of tub bathing and sponge bathing on neonatal comfort and physiological parameters in late preterm infants: A randomized controlled trial

BackgroundIncreasing comfort and physiological stabilization in preterm infants during neonatal care improves their neurophysiological development. Bathing procedures that support this development and will not expose the newborn to stress should be preferred. ObjectivesOur study aimed to examine the effectiveness of tub bathing and sponge bathing methods on the physiological parameters (i.e., heart rate, respiration rate, oxygen saturation, body temperature) and comfort of late preterm infants. DesignRandomized controlled trial. Study is registered at ClinicalTrials.gov NCT03796312. SettingsThe trial was conducted in a neonatal intensive care unit of a university hospital in Antalya, Turkey. MethodsLate preterm infants (gestational age between 34 0/7 weeks and 36 6/7 weeks) were randomly assigned by a computer program to either intervention (tub bath) or control group (sponge bath). The physiological parameters and comfort of preterm infants in both groups were evaluated at 10 min before the bath. Infant comfort was reevaluated 10 min after the procedure, while physiological parameters were reevaluated after 15 and 30 min. Preterm infant heart rate, oxygen saturation, respiratory rate, body temperature and comfort behaviors were assessed by two independent evaluators who were blinded to the purpose of the study at different phases across the two bathing protocols. Written consent was obtained from the university and hospital ethics committee where the research was performed, and from the families of the infants participating in the study. SPSS 20.0 and SAS 9.3 were used for data analysis. Data was analyzed by percentage distribution, mean, repeated analysis, variance analysis, Bonferroni analysis as a further analysis and t-test in dependent groups. ResultsApproximately 120 preterm infants completed the protocol (60 in each group). The two groups did not differ in gestational age, sex, weight or other demographic variables (p > 0.05). Tub bathing was more effective in reducing preterm infants’ comfort scores (9.47 ± 2.55 vs. 14.85 ± 4.77, p < 0.001) and heart rate than sponge bathing (132.88 ± 12.00 vs. 144.00 ± 17.74, p < 0.05). Preterm infants in the tub bathing group maintained their body temperature better than those in the sponge bathing group (36.75 ± 0.26 vs. 36.59 ± 0.25, p < 0.05). There was no difference in oxygen saturation (98.35 ± 0.88 vs. 97.85 ± 1.36, p = 0.291) or respiratory rate (45.57 ± 5.39 vs. 47.20 ± 5.41, p = 0.472) between the tub and sponge bathing groups. ConclusionsTub bathing is a safer, more pleasurable/comfortable bathing option and is the recommended method for bathing healthy, late preterm infants.

Erratum: Effect of music (Brahms lullaby) and non-nutritive sucking on heel lance in preterm infants: A randomized controlled crossover trial.

[This corrects the article DOI: 10.1093/pch/pxy072.].

Effect of music (Brahms lullaby) and non-nutritive sucking on heel lance in preterm infants: A randomized controlled crossover trial.

ObjectivesThis study examined a more effective pain management method, without sucrose, on heel lance in preterm infants using the Premature Infant Pain Profile (PIPP).DesignIn a nonblinded, randomized controlled, two-period, two-sequence crossover trial, 25 infants were randomly allocated to intervention (a Brahms lullaby with non-nutritive sucking, facilitated tucking and holding) or standard care (facilitated tucking and holding).SettingLocal Perinatal Medical Centre’s NICU in Japan, July 2014 until June 2015.Outcome measuresThe primary outcome variable was PIPP, and secondary outcomes were heart rate (HR), oxygen saturation, and abnormal HR (> baseline mean plus 2 SDs, or <120 minus 2 SDs).ResultsThe infants were 33.8 weeks gestational age at birth, 1,983.7 g birth weight, and 32 to 35 weeks postconceptual age. At all 10 measurement points, constructed of every 30 seconds postheel lance, mean PIPP of infants during the intervention (3.6 to 2.4) was significantly lower than during the standard care (8.0 to 4.6) (range, P=0.0039 to P<0.0001). All PIPP reduction rates from the 30 seconds point were similar between the two groups. The HR of preterm infants at the 120 seconds points were significantly lower (P=0.0151), and the HRs of 6 points were considerably lower during the intervention than during the standard care (range, P≤0.0879 to P≥0.049). The abnormal HR total number was significantly lower during the intervention (2) than the standard care (23) (frequency ratio=0.087, P<0.0001).ConclusionThis method demonstrated stronger analgesia, early pain relief, and maintenance of homeostasis on heel lance in preterm infants.

Lullaby effect with mother’s voice on respiratory rate and the speed of its return to the pre-suction state in intubated preterm infants, during tracheal tube suction Kerman, Afzali pour hospital 2016

Introduction & Objective:Acceptance of newborns in the intensive care unit is regarded as one of the most important health care challenges due to the use of painful invasive procedures that are frequently performed on admitted infants. Today, the use of palliative non-pharmacological methods has been repeatedly emphasized in the literature. Therefore, the present study determine lullabies effect with mother’s voice on heart rate in preterm infants during tracheal tube suction.Materials and Methods:This cross over-interventional study was conducted on 40 preterm infants during a five-month period in 2016, who were admitted in NICU in the Afzalipour Hospital affiliated to Kerman University of Medical Sciences. After convenience random sampling, infants were divided into two groups of Routine care / Lullaby and Lullaby / Routine care. At the intervention time, mother’s lullaby was played for the infants from the 5 minutes before suction until 10 minutes later. Physiological responses of infants, including respiratory rate, were measured one minute before endotracheal suctioning as baseline information and five minutes to thirty minutes continued after suction. Finally, statistical analysis of data was performed by SPSS software version 23.Results:The results showed that mother’s lullaby in intubated preterm infants who were suctioned, not only was effective on fast return of breathing changes after the suction, but also it reduced respiratory rate (0.007 p), which can also indicate the stress reduction in infants.Conclusion:The participation and presence of mothers in taking care of preterm infants not only improves the quality of nursing care, but can also has a significant effect on their physiological responses.

Oxygen Saturation and Heart Rate Ranges in Very Preterm Infants Requiring Respiratory Support at Birth

To evaluate the changes in preductal oxygen saturation (SpO2) and heart rate in preterm infants receiving continuous positive airway pressure (CPAP) and/or positive-pressure ventilation (PPV) at birth. A prospective observational study at birth of infants aged <32 weeks separated into 2 gestational age (GA) groups: 230/7-276/7 weeks (group 1) and 280/7-316/7 weeks (group 2). Infants received delayed cord clamping (DCC) in accordance with institutional protocol. CPAP and/or PPV was applied at the clinical team's discretion. SpO2 and heart rate were recorded every minute for 10 minutes. Preductal SpO2 was targeted according to published nomograms. For heart rate, the goal was to maintain a stable heart rate >100 bpm. The study cohort comprised 96 group 1 infants (mean GA, 26 ± 1 weeks; mean birth weight, 818 ± 208 g) and 173 group 2 infants (mean GA, 30 ± 1 weeks; mean birth weight, 1438 ± 374 g). In general, infants requiring respiratory support reached target values for heart rate and SpO2 more slowly than the published nomograms for spontaneously breathing preterm infants without respiratory support. Infants receiving CPAP reached SpO2 and heart rate targets faster than infants receiving PPV. In group 1, but not group 2 infants, DCC resulted in higher SpO2 and heart rate. SpO2 and heart rate do not quickly and reliably reach the values achieved by spontaneously breathing preterm infants not requiring respiratory support.

The 30-second rule: the effects of prolonged intubation attempts on oxygen saturation and heart rate in preterm infants in the delivery room.

A duration of 30 seconds has been shown to improve the success rate of intubation attempts without any decompensation. There is limited data regarding the detrimental effects of prolonged intubation attempts in preterm infants. The aim was to determine the effect of prolonged intubation attempts on heart rate and oxygen saturation in preterm infants. We retrospectively reviewed videos and physiologic data collected during delivery room (DR) resuscitations. Infants who had a functioning pulse oximeter at the time of intubation in the delivery room were analyzed using video and analog recordings. The duration of the intubation attempt was defined as the time the laryngoscope blade was in the infant's mouth. Prolonged intubations were defined as intubations over 30 seconds. Baseline heart rate and saturations were defined as the heart rate and saturation immediately prior to the intubation attempt. Video recording was used to determine time laryngoscope was in the mouth, what other procedures were performed, and whether there was recovery between attempts. Analog data including heart rate, airway pressure and saturation was also recorded. There were 52 intubation attempts in 28 infants. The median (IQR) birth weight and gestational age were 795 (705, 972) grams and 25 (25, 27) weeks. The duration of an intubation attempt was 35 (27, 46) seconds with number of attempts 2 (1, 2). There were 34 intubation attempts greater than 30 seconds (prolonged group) and 18 attempts less than or equal to 30 seconds (short group). Longer attempts did not affect intubation success (successful 34 [25,37] seconds vs. unsuccessful 41[29, 53] seconds; P=0.05). Infants in the prolonged group had a greater decrease in oxygen saturation percentage from baseline (5±8 percent, short intubation group and 13±27 prolonged intubation group; P=0.004). There was also a significant decrease in heart rate beats per minute between the two groups (6±9 in the short intubation group and 23±29 prolonged group; P=0.004). The currently recommended guideline by the Neonatal Resuscitation Program limiting intubation attempts to less than 30 seconds is supported by stable oxygen saturations and heart rate. Prolonging the intubation more than 30 seconds leads to greater hypoxia and may contribute to increased neonatal morbidity, with no effect on success rate.

Evidence-Based Review of Physiologic Effects of Kangaroo Care

A comprehensive review of the evidence documenting preterm infant physiologic responses to Kangaroo Care (KC – intermittent skin-to-skin contact) and Kangaroo Mother Care (KMC – 24/7 skin-to-skin contact) has been conducted. Kangaroo Care's effects on preterm infant heart rate, bradycardia, respiratory rate, apnea, oxygen saturation, cerebral oxygenation, supplemental oxygen needs, oxygen consumption, desaturation episodes, temperature, rewarming, blood glucose, serum bilirubin, cholecystokinin, gastrin, somatostatin, weight gain or change, sleep and crying, brain maturation and complexity, infection, stress, and pain are reviewed, as are KC's effects with congenital heart defect infants. Documented effects of KC on prevention and amelioration of maternal depression, swifter delivery of the placenta and involution, and decreased likelihood of postpartal anemia are presented. Guidelines based on dosage (duration and frequency) of KC are provided, as is a summary of actual and potential benefits of KC, including use at end-of-life. Kangaroo Care's role in moving to the new paradigms of non-separation of the infant and mother during hospitalization and parents as primary providers of neonatal care concludes the manuscript.

Effects of Cycled Lighting on Heart Rate in Preterm Infants: Comparing the Use of Standard and Individual Heart Rate Criteria

Effects of Cycled Lighting on Heart Rate in Preterm Infants: Comparing the Use of Standard and Individual Heart Rate Criteria

Effects of Cycled Lighting on Heart Rate in Preterm Infants: Comparing the Use of Standard and Individual Heart Rate Criteria

Effects of Cycled Lighting on Heart Rate in Preterm Infants: Comparing the Use of Standard and Individual Heart Rate Criteria

24-Hour Electrocardiogram before and during Cisapride Treatment in Neonates and Infants

We studied prospectively the effects of cisapride on heart rate and rhythm using standard ECG and 24-hour ECG recordings in term and preterm neonates and infants. We studied subjects with gastroesophageal reflux disease (apparent life-threatening events, apneas, bradycardias) before and 3 days after starting cisapride (0.8 mg/kg/day in 4 doses). We performed standard ECGs for determination of corrected Q-T interval (QTc) and Q-T dispersion (QTd) and 24-hour ECG recordings for analysis of heart rate, heart rate variability, and heart rhythm. Fourteen term and 17 preterm subjects (gestational age range 28–36 weeks) were studied at a median chronological age of 29 (range 3–132) days. Cisapride significantly increased the QTc in preterm infants (before vs. after: 408 ± 7 vs. 433 ± 7 ms, p = 0.001). Two preterm and 1 term infant had a QTc >450 ms before cisapride. Four preterm (4/15 = 27%) and 2 term (2/13 = 15%) subjects had a QTc >450 ms on cisapride. After cisapride the QTd remained normal, and no relevant arrhythmias were documented on Holter recordings. Cisapride significantly decreased peak and mean heart rates of all study subjects without affecting the heart rate variability, while it increased the minimal heart rate of preterm infants only (before vs. after: 66 ± 5 vs. 78 ± 5 bpm, p = 0.02). The maximally measured R-R intervals (pauses) decreased after cisapride in preterm infants (before vs. after: 1.33 ± 0.2 s vs. 1.05 ± 0.2 s, p = 0.04). Although cisapride did cause a significant prolongation of the ventricular action potential duration in preterm infants, the QTd remained unaffected, and no clinically relevant arrhythmias were documented in this small sample. On the other hand, cisapride had a direct lowering effect on the maximal and mean heart rates of both term and preterm infants, while the drug increased the minimal heart rate and reduced the severity of bradycardia episodes in preterm infants.

Interaction between respiration and heart rate in preterm infants and developmental changes. I. Quiet sleep stage

Interaction between respiration and heart rate in preterm infants and developmental changes. I. Quiet sleep stage

Postural effects on pulmonary function and heart rate of preterm infants with lung disease

Frequency (breaths/min) Tidal volume (ml/kg) Minute ventilation (ml/min/kg) Compliance (ml/cm H20/kg) Conductance (L/sec/cm H20) Resistive work of breathing (gm-cm/kg) Peak pressure change (era H20) 66 + 3 71 + 4 6.0 + 0.4 6.0 + 0.5 389 _+ 27 391 _+ 27 1.12 _+ 0.09 0.94 _+ 0.11 0.027 + 0.005 0.014 0.007* 12 + 3 19 _+ 3* 6.5 --0.9 7.7 ----0.7* 6 7 + 3 6.0 + 0.4 390 + 26 1.28 _+ 0.14 0.023 _+ 0.003 1 1 + 2 5.7 + 0.8

Handling Preterm Infants in Hospitals: Stimulating Controversy About Timing of Stimulation

The authors' research draws from a primary concern for the effects of the animate and inanimate caregiving environment on brain growth and central nervous system organization in hospitalized preterm infants. The current report presents data on physiologic trends in preterm infant heart rate and oxygenation as related to the timing and content of caregiver stimulation, specifically medical and social forms of touch. Results indicate that while most instances of bradycardia were not closely preceded by tactile stimulation, prebradycardia periods, which included touch, had lower pO2 levels than did baseline periods that included touch. These findings suggest that medical or "developmental" tactile stimulation presented when the infant was already physiologically compromised (with low pO2) may potentiate an underlying vulnerability to bradycardia. Timing, versus type, may be the better predictor of the physiologic effect of caregiver interventions on preterm infants.