Background and Aim Brain injury may lead to autonomic nervous system dysfunction reflected by abnormal heart rate characteristics (HRC). A HRC monitor was developed to analyze heart rate variability and decelerations and predict catastrophic illness in NICU patients (HeRO monitor). We tested the hypothesis that the HRC index would be abnormally high in preterm infants with abnormal brain ultrasound and MRI.

Methods We collected HRC data on extremely low birthweight infants who underwent brain MRI as part of a study of neurodevelopmental outcomes. Brain ultrasounds (US) were performed in the first week and as clinically indicated, and brain MRI was performed near discharge. US were scored as normal/mild (including grades 1–2 IVH) and moderate/severe (grades 3–4 IVH or cystic periventricular leukomalacia). MRI was scored 0–3 for gray and white matter injury.

Results 45 ELBW infants with MRI performed had HRC data available. MRI was classified as 0 (normal, n=22), 1 (mild, n=14), 2 (moderate, n=5) or 3 (severely abnormal, n=4) and US as normal/mild (n=36) or moderate/severe (n=9). Average HRC index in the first 28 days after birth (aHRC28) was highly correlated with severity of abnormal brain US and MRI. aHRC28 for patients with normal/mild US abnormalities was 1.37±0.48 (mean±SD) and with moderate/severe 2.53±0.69 (p<0.001). For MRI, aHRC28 for patients with classes 0–3 was 1.24±0.44, 1.59±0.53, 2.49±0.68*, 2.72±0.82*, (*p<0.001 versus class 0). Differences persisted after adjustment for gestational age and birthweight.

Conclusion HRC monitoring may be a useful adjunct test for severity of brain injury in NICU patients.