Paper
Friday, 21 July 2006
This presentation is part of : Programs and Models in Acute Care
Heart Rate Variability Responses to Feeding for Preterm Infants with BPD
Gail C. McCain, PhD, RN, FAAN and Jessica Loucas, MSN, RN, CPNP. Nursing, University of Miami, Coral Gables, FL, USA
Learning Objective #1: define heart rate variability.
Learning Objective #2: describe heart rate variability responses of preterm infants with BPD during feeding.
Objective:  To describe heart rate variability (HRV) and beat-to-beat heart rates of preterm infants with bronchopulmonary dsyplasia (BPD) on introduction to nipple feeding.  HRV provides an indirect measure of the sympathetic and parasympathetic components of the autonomic nervous system’s influence on heart rate.

Design:  A descriptive pilot study was conducted.

Sample/Setting: Four preterm infants (birth gestational ages 24, 25, 28, and 33 weeks) with BPD were recruited when they started to nipple feed.  Three infants were receiving supplemental oxygen at the start of nipple feeding. Data were collected in a level III nursery.

Methods:  HRV and heart rate were measured with a non-invasive signal monitoring system that captured the ECG and respiratory activity.  A density spectral analysis generated the respiratory activity component (Rfa) and low frequency component (Lfa) of the HRV spectrum. Behavioral responses were measured with the Anderson Behavioral State Scale.  Data were collected during two nipple feedings; one each during the first and second weeks of feeding. 

Findings:  The infant without supplemental oxygen achieved nipple feeding in 7 days, while the other infants took 8, 13, and 23 days.  Overall, the infants were able to maintain awake behavior for the majority of time during feeding. Heart rates ranged from 139-191 bpm at baseline and 118-195 bpm during feeding. HRV indices were lower during feeding than baseline in all infants, and the LF indices were higher than HF indices for all infants during feeding. Heart rates >160 bpm at baseline and during feeding reflect the burden of BPD on the cardiovascular system. The trend for a decrease in LF and HF indices during feeding reflects the sensory stimulation and work of nipple feeding. Higher LF than HF during feeding reflects a sympathetic dominance with feeding activity. The indices also suggest that these infants are capable of regulating sympatho-vagal responses.

             

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