Heart Rate Variability as a Prognostic Tool for Gastroschisis Infants in the Neonatal Intensive Critical Unit

Abstract

Objective Gastroschisis is the most common congenital abdominal wall defect, with an increasing incidence. It results in extrusion of abdominal contents with associated delayed intestinal motility. Abnormal heart rate characteristics (HRCs) such as decreased variability occur due to the inflammatory response to sepsis in preterm infants. This study aimed to test the hypothesis that infants with gastroschisis have decreased heart rate variability (HRV) after birth and that this physiomarker may predict outcomes.

Study Design We analyzed heart rate data from and clinical variables for all infants admitted with gastroschisis from 2009 to 2020.

Results Forty-seven infants were admitted during the study period and had available data. Complex gastroschisis infants had reduced HRV after birth. For those with sepsis and necrotizing enterocolitis, abnormal HRCs occurred early in the course of illness.

Conclusion Decreased HRV was associated with complex gastroschisis. Infants in this group experienced complications that prolonged time to full enteral feeding and time on total parenteral nutrition.

Key Points

• Infants with gastroschisis can be classified into two subcategories, simple and complex disease.

• Those with complex disease often require prolonged stays in the neonatal intensive care unit and costly hospitalizations. We hypothesized that infants with complex gastroschisis are more likely to have abnormal HRC due to intestinal inflammation.

• In this study, we identified associations between abnormal HRV, heart rate characteristicHRC, and the development of gastroschisis complications. Additionally, we described differences in clinical characteristics between infants with complex versus simple gastroschisis.

Keywords

abdominal defect - congenital anomaly - heart rate characteristics - heart rate variability - gastroschisis

Ethical Approval

The UVA Institutional Review Board reviewed and approved the study protocol. This study was performed in accordance with the Declaration of Helsinki.

Publication History

Received: 19 September 2023

Accepted: 10 January 2024

Accepted Manuscript online:
12 January 2024

Article published online:
28 February 2024

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