Effects of regional brain injury on the newborn autonomic nervous system

Objective: Cerebral mapping of central autonomic nervous system (ANS)(1) function in mature animals and humans lateralizes sympathetic and parasympathetic influence predominantly to the right and left cerebral hemispheres, respectively. Spectral analysis of heart rate variability (HRV)(2) is an established measure of ANS function. We examined whether such lateralization is present in the term newborn. Methods: We retrospectively reviewed records of infants >36 weeks of gestation diagnosed with hypoxic ischemic encephalopathy (HIE)(3). We included infants with neonatal EEG and regional injury on brain MRI, which was scored using a schema. We extracted ECG signals from the EEG recording, but excluded periods of electrographic seizure activity to eliminate possible seizure influence on HRV. HRV was evaluated by spectral analysis in the high frequency (HF4; 0.3-1 Hz) and low frequency (LF5; 0.05-0.25 Hz) ranges, and the LF/HF ratio was examined to assess sympatho-vagal balance. The relation between the injured brain regions and HRV was studied using multiple linear regression models. Results: We studied 40 neonates with HIE. Injury to the right cerebral cortex (p = 0.009) and right cerebellum (p = 0.041) predicted a decreased LF/HF ratio. Injury to the left cerebral cortex (p = 0.035) and left cerebellum (p = 0.041) was associated with an increased LF/HF ratio. The association between brain injury location and the individual LF or HF spectral powers of brain injury did not reach significance. Conclusions: Our data suggest that a functional lateralization for cerebral autonomic influence is established by term gestation. (C) 2014 Elsevier Ireland Ltd. All rights reserved.