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Meister AL, Gardner FC, Browning KN, et al. Vagal Tone and Proinflammatory Cytokines Predict Feeding Intolerance and Necrotizing Enterocolitis Risk. Adv Neonatal Care. 2021;21(6):452-461doi: 10.1097/ANC.0000000000000959.
Meister, A. L., Gardner, F. C., Browning, K. N., Travagli, R. A., Palmer, C., & Doheny, K. K. (2021). Vagal Tone and Proinflammatory Cytokines Predict Feeding Intolerance and Necrotizing Enterocolitis Risk. Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 21(6), 452-461. https://doi.org/10.1097/ANC.0000000000000959
Meister, Alissa L, et al. "Vagal Tone and Proinflammatory Cytokines Predict Feeding Intolerance and Necrotizing Enterocolitis Risk." Advances in neonatal care : official journal of the National Association of Neonatal Nurses vol. 21,6 (2021): 452-461. doi: https://doi.org/10.1097/ANC.0000000000000959
Meister AL, Gardner FC, Browning KN, Travagli RA, Palmer C, Doheny KK. Vagal Tone and Proinflammatory Cytokines Predict Feeding Intolerance and Necrotizing Enterocolitis Risk. Adv Neonatal Care. 2021 Dec 01;21(6):452-461. doi: 10.1097/ANC.0000000000000959. PMID: 34847103; PMCID: PMC8638911.
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Adv Neonatal Care. 2021 Dec 01;21(6):452-461. doi: 10.1097/ANC.0000000000000959.

Vagal Tone and Proinflammatory Cytokines Predict Feeding Intolerance and Necrotizing Enterocolitis Risk.

Advances in neonatal care : official journal of the National Association of Neonatal Nurses

Alissa L Meister, Fumiyuki C Gardner, Kirsteen N Browning, R Alberto Travagli, Charles Palmer, Kim Kopenhaver Doheny

Affiliations

  1. Department of Neural and Behavioral Sciences (Drs Meister, Browning, Travagli, and Doheny), and Division of Neonatal-Perinatal Medicine, Department of Pediatrics (Drs Gardner, Palmer and Doheny), College of Medicine, The Pennsylvania State University, Hershey.

PMID: 34847103 PMCID: PMC8638911 DOI: 10.1097/ANC.0000000000000959

Abstract

BACKGROUND: Necrotizing enterocolitis (NEC) is the leading cause of death due to gastrointestinal disease in preterm neonates; yet, clinicians lack reliable and noninvasive predictive tools.

PURPOSE: We aimed to test that diminished high-frequency heart rate variability (HF-HRV) and elevated levels of proinflammatory cytokines would have utility in NEC prediction.

METHODS: In this multisite prospective study, we enrolled 250 preterm (26-34 weeks' postmenstrual age [PMA]) neonates with physiological stability at 72 hours of life. HRV was measured noninvasively using electrocardiograhic data from standardized cardiorespiratory monitors at postnatal week 1 of life and weekly thereafter until 35 weeks' PMA or discharge; blood was collected for cytokines at postnatal weeks 1 and 3. NEC was diagnosed via Modified Bell's Staging Criteria.

RESULTS: HF-HRV was decreased at weeks 1 and 2 in neonates (47% females) who developed feeding intolerance or stage 2+ NEC. In addition, these neonates displayed elevated levels of IL-8 at week 1 and increased levels of IL-1β, IL-6, TNF-α, and IL-8 at week 3 of life. Low HF-HRV was associated with elevated IL-6 or IL-8 levels at weeks 1 and 3 of life. Logistic regression indicated that only HF-HRV was a significant predictor of feeding intolerance or NEC development.

IMPLICATIONS FOR PRACTICE AND RESEARCH: HRV is a promising noninvasive modality for NEC risk detection. The association of low HF-HRV with elevated proinflammatory cytokines provides evidence for a putative role of the vagal cholinergic pathway in NEC pathogenesis. Future studies should focus on application of these techniques to test clinical therapeutics.Video Abstract available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=54.

Copyright © 2021 by The National Association of Neonatal Nurses.

Conflict of interest statement

K.K.D. and C.P. are inventors on a US patent that describes analytic methods used for heart rate variability to determine necrotizing enterocolitis risk. This patent is owned by The Pennsylvania State

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