Published online March 2, 2009
PEDIATRICS Vol. 123 No. 3 March 2009, pp. 810-815 (doi:10.1542/peds.2008-0253)
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ARTICLE

Altered Heart Rhythm Dynamics in Very Low Birth Weight Infants With Impending Intraventricular Hemorrhage

Volkan Tuzcu, MDa, Selman Nas, PhDa, Umit Ulusar, MSb, Ahmet Ugur, PhDc and Jeffrey R. Kaiser, MD, MAd

a Division of Cardiology, Department of Pediatrics,
d Division of Neonatology, Departments of Pediatrics and Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
b Department of Applied Science, University of Arkansas, Little Rock, Arkansas
c Department of Computer Science, Central Michigan University, Mt Pleasant, Michigan

OBJECTIVE. Intraventricular hemorrhage remains an important problem among very low birth weight infants and may result in long-term neurodevelopmental disabilities. Neonatologists have been unable to accurately predict impending intraventricular hemorrhage. Because alterations in the autonomic nervous system's control of heart rhythm have been associated with intraventricular hemorrhage after its development, we sought to determine if early subtle alterations of heart rhythm could be predictive of impending intraventricular hemorrhage in very low birth weight infants.

METHODS. This case-control study included 10 newborn very low birth weight infants with intraventricular hemorrhage (5 grade IV, 4 grade III, and 1 grade II) and 14 control infants without intraventricular hemorrhage. Heart rhythm data from the first day of life before the development of intraventricular hemorrhage were evaluated. Detrended fluctuation analysis, a nonlinear fractal heart rate variability method, was used to assess the fractal dynamics of the heart rhythm. Fractal scaling exponents were calculated by using this analysis.

RESULTS. Twenty-four infants (mean ± SD, birth weight: 845 ± 213g: gestational age: 26.1 ± 1.9 weeks) participated in the study. The short-term scaling exponent was significantly larger in infants who later developed intraventricular hemorrhage compared with those who did not (0.60 ± 0.1 vs 0.45 ± 0.1). A value of 0.52 resulted in 70% sensitivity and positive predictive value and 79% specificity and negative predictive value. The short-term scaling exponent was the only significant predictor of intraventricular hemorrhage.

CONCLUSIONS. Fractal dynamics of the heart rhythm is significantly altered in very low birth weight infants before developing intraventricular hemorrhage and may be predictive of impending intraventricular hemorrhage.

Key Words: intraventricular hemorrhage • prematurity • very low birth weight infants • heart rate variability fractal analysis • detrended fluctuation analysis

Abbreviations: IVH—intraventricular hemorrhage • VLBW—very low birth weight • HRV—heart rate variability • DFA—detrended fluctuation analysis

Accepted Jun 25, 2008.


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