Daniel A Reich1, Rathinaswamy B Govindan1, Matthew T Whitehead2, Jichuan Wang3, Taeun Chang4, Srinivas Kota1, Adre J du Plessis5. 1. Fetal Medicine Institute, Children's National Health System, 111 Michigan Avenue NW, Washington, DC, 20010, USA. 2. Division of Diagnostic Imaging and Radiology, Children's National Health System, 111 Michigan Avenue NW, Washington, DC, 20010, USA. 3. Division of Biostatistics and Study Methodology, Children's National Health System, 111 Michigan Avenue NW, Washington, DC, 20010, USA. 4. Division of Neurology, Children's National Health System, 111 Michigan Avenue NW, Washington, DC, 20010, USA. 5. Fetal Medicine Institute, Children's National Health System, 111 Michigan Avenue NW, Washington, DC, 20010, USA. adupless@childrensnational.org.
Abstract
BACKGROUND: The mature cerebral cortex has a topographically organized influence on reflex autonomic centers of the brainstem and diencephalon and sympathetic activation coming primarily from the right hemisphere and parasympathetic activation from the left. In the term newborn, the maturational status of this central autonomic system remains poorly understood. METHODS: Sixteen term newborns admitted to Children's National with unilateral middle cerebral artery (MCA) strokes (n = 8 left, n = 8 right) had archived continuous electrocardiograph (EKG) signals available. We compared stroke laterality and severity with indices of autonomic function, as measured by heart rate variability. We performed both time- and frequency-domain analyses on the R-R interval (RRi) over 24h of continuous EKG data at around 7 days of age. RESULTS: Right MCA stroke significantly increased sympathetic tone, while left MCA stroke increased parasympathetic tone. Regardless of laterality, stroke severity was associated inversely with sympathetic tone and positively with parasympathetic tone. Surprisingly, injury to either insular region had no significant autonomic effect. Phenobarbital blood levels were positively associated with sympathetic tone and inversely related to parasympathetic tone. CONCLUSION: Based on these findings, it is difficult to reconcile the functional topography of the central autonomic system in term newborns with that currently proposed for the normal mature brain. Further investigation is clearly needed.
BACKGROUND: The mature cerebral cortex has a topographically organized influence on reflex autonomic centers of the brainstem and diencephalon and sympathetic activation coming primarily from the right hemisphere and parasympathetic activation from the left. In the term newborn, the maturational status of this central autonomic system remains poorly understood. METHODS: Sixteen term newborns admitted to Children's National with unilateral middle cerebral artery (MCA) strokes (n = 8 left, n = 8 right) had archived continuous electrocardiograph (EKG) signals available. We compared stroke laterality and severity with indices of autonomic function, as measured by heart rate variability. We performed both time- and frequency-domain analyses on the R-R interval (RRi) over 24h of continuous EKG data at around 7 days of age. RESULTS: Right MCA stroke significantly increased sympathetic tone, while left MCA stroke increased parasympathetic tone. Regardless of laterality, stroke severity was associated inversely with sympathetic tone and positively with parasympathetic tone. Surprisingly, injury to either insular region had no significant autonomic effect. Phenobarbital blood levels were positively associated with sympathetic tone and inversely related to parasympathetic tone. CONCLUSION: Based on these findings, it is difficult to reconcile the functional topography of the central autonomic system in term newborns with that currently proposed for the normal mature brain. Further investigation is clearly needed.
Authors: Sarah B Mulkey; Laura Hitchings; Reva Persaud; Srinivas Kota; G Larry Maxwell; Robin Baker; Adre du Plessis; Rathinaswamy Govindan Journal: Clin Auton Res Date: 2021-03-14 Impact factor: 5.625
Authors: Sarah B Mulkey; Srinivas Kota; Rathinaswamy B Govindan; Tareq Al-Shargabi; Christopher B Swisher; Augustine Eze; Laura Hitchings; Stephanie Russo; Nicole Herrera; Robert McCarter; G Larry Maxwell; Robin Baker; Adre J du Plessis Journal: Sci Rep Date: 2019-07-30 Impact factor: 4.379
Authors: Sarah D Schlatterer; Rathinaswamy B Govindan; Scott D Barnett; Tareq Al-Shargabi; Daniel A Reich; Sneha Iyer; Laura Hitchings; G Larry Maxwell; Robin Baker; Adre J du Plessis; Sarah B Mulkey Journal: Pediatr Res Date: 2021-03-02 Impact factor: 3.756