Elsevier

The Journal of Pediatrics

Volume 182, March 2017, Pages 92-98.e1
The Journal of Pediatrics

Original Articles
Features of Heart Rate Variability Capture Regulatory Changes During Kangaroo Care in Preterm Infants

https://doi.org/10.1016/j.jpeds.2016.11.059Get rights and content

Objective

To determine whether heart rate variability (HRV) can serve as a surrogate measure to track regulatory changes during kangaroo care, a period of parental coregulation distinct from regulation within the incubator.

Study design

Nurses annotated the starting and ending times of kangaroo care for 3 months. The pre-kangaroo care, during-kangaroo care, and post-kangaroo care data were retrieved in infants with at least 10 accurately annotated kangaroo care sessions. Eight HRV features (5 in the time domain and 3 in the frequency domain) were used to visually and statistically compare the pre-kangaroo care and during-kangaroo care periods. Two of these features, capturing the percentage of heart rate decelerations and the extent of heart rate decelerations, were newly developed for preterm infants.

Results

A total of 191 kangaroo care sessions were investigated in 11 preterm infants. Despite clinically irrelevant changes in vital signs, 6 of the 8 HRV features (SD of normal-to-normal intervals, root mean square of the SD, percentage of consecutive normal-to-normal intervals that differ by >50 ms, SD of heart rate decelerations, high-frequency power, and low-frequency/high-frequency ratio) showed a visible and statistically significant difference (P <.01) between stable periods of kangaroo care and pre-kangaroo care. HRV was reduced during kangaroo care owing to a decrease in the extent of transient heart rate decelerations.

Conclusion

HRV-based features may be clinically useful for capturing the dynamic changes in autonomic regulation in response to kangaroo care and other changes in environment and state.

Section snippets

Methods

The Máxima Medical Center has an 18-bed, level III, tertiary neonatal intensive care unit (NICU) with private rooms in which kangaroo care is practiced routinely. Parents are encouraged to perform kangaroo care for durations of 60 minutes or longer. Routine patient monitoring continues during kangaroo care, including electrocardiography (ECG), HR, RR (using impedance pneumography), SpO2, and temperature (measured in the diaper). The patient monitors (IntelliVue MX 800; Philips, Hamburg,

Results

We analyzed data from the 30-minute stable epochs during kangaroo care for changes in vital signs and HRV features compared with the pre-kangaroo care incubator period, in a total of 191 kangaroo care sessions provided to 11 preterm infants. For vital signs, small changes were seen in HR and RR (P <.01). For the pre-kangaroo care and during-kangaroo care epochs, the median (interdecile) values for HR were 159 (146-170) and 156 (145-167), respectively, and 49 (42-62) and 47(38-61),

Discussion

In this study, we analyzed the effect of kangaroo care on features of HRV by investigating 191 kangaroo care sessions in 11 preterm infants. Six features―SDNN, RMSSD, pNN50, SDDec, HF power, and LF/HF―showed statistically significant and clearly visible differences in the during-kangaroo care period compared with the pre-kangaroo care period, and changes in vital signs were small and clinically irrelevant. Although stable vital signs during kangaroo care have been reported previously,1, 2, 7

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    The authors declare no conflicts of interest.

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    Contributed equally.

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