Heart rate variability and cardiac reflexes in small for gestational age infants

Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand Submitted 4 October 2005 ; accepted in final form 22 November 2005 To assess the influence of intrauterine growth retardation and postnatal development on heart rate variability (HRV) and cardiac reflexes, we studied 27 healthy small for gestational age (SGA) and 23 appropriate for gestational age (AGA) infants during a nap study. Resting HRV was assessed by point dispersion of Poincaré plots for overall (SDRR) and instantaneous beat-to-beat variability (SD RR) and the ratio (SDRR/SD RR). Heart rate reflex and arousal responses to a 60° head-up tilt were determined. All tests/measures were repeated twice in quiet and active sleep and in prone and supine sleep positions at 1 and 3 mo of age. SGA infants exhibited higher resting sympathetic tone [SDRR/SD RR: 1.9 (95% confidence interval: 1.7, 2.0) and 1.7 (95% confidence interval: 1.5, 1.8) in SGA and AGA, respectively; P = 0.046] and a tendency for a smaller tachycardic reflex response to the tilt [ heart rate: 24 beats/min (95% confidence interval: 20, 28) and 30 (95% confidence interval: 25, 34)] in SGA and AGA, respectively; P = 0.06]. HRV indexes were reduced in the prone compared with supine position ( P < 0.0001), but reflex tilt responses were unchanged with position. SGA/AGA differences were independent of sleep position. Gestational age weight status did not influence the likelihood of arousal, but prone sleeping per se reduced the odds 2.5-fold. The findings suggest reduced autonomic activity and cardiac reflexes in SGA infants. The finding that the sympathetic component of the control of HRV was higher in SGA infants could link with findings in adulthood of an association between being born SGA and a higher risk of cardiovascular disease. heart rate variability; intrauterine growth retardation; prone position; sudden infant death syndrome; supine position; tilting; small gestational age Address for reprint requests and other correspondence: B. Galland, Dept. of Women’s and Children’s Health, Dunedin School of Medicine, Univ. of Otago, PO Box 913, Dunedin, New Zealand (e-mail: barbara.galland{at}stonebow.otago.ac.nz )