PECULIARITIES OF AUTONOMIC REGULATION IN INFANTS WHO SUFFERED FROM INTRAUTERINE HYPOXIA DURING DIFFERENT WAYS OF DELIVERY
DOI: 10.22138/2500-0918-2018-15-6-814-823
T.S. Tumaeva, L.S. Celkovich, E.I. Naumenko,
E.S. Samoshkina, S.V. Garina,
V.S. Vereshchagina, A.A. Shirokova
Mordovia Republican Central Clinical Hospital, Saransk, Russian Federation;
N.P. Ogarev Mordovia State University, Saransk, Russian Federation;
Samara State Medical University, Samara, Russian Federation
Abstract. Objective. Based on the results of Holter ECG monitoring and electroencephalography, to study the peculiarities of autonomic regulation and brain activity in infants, who suffered from intrauterine hypoxia during different way of delivery. Patients and methods. 475 newborns, who suffered from hypoxia, were divided into two groups. Group 1 — 290 cesarean-born children; Group 2 — 185 vaginally-born children. The survey included Holter ECG monitoring and sleep electroencephalography performed initially in the neonatal period, then at 3, 6 and 12 months. Results. According to the results of Holter ECG, myocardial electrical instability and arrhythmogenic cardiomyopathy were more common in the neonatal period among the cesarean-born children, who suffered from hypoxia, since these conditions were observed against the background of severe autonomic imbalance with reduced sympathetic activity (increased rMSSD and pNN50). In comparison with the vaginally-born children, the cesarean-born children had more frequent pathological pauses in heart rhythm (18.9% versus 10.3%, p=0.010) and longer QTc intervals (p=0.048). Their rhythm disturbances were more often recorded as bradyarrhythmias. According to the results of electroencephalography, a delayed development of the central nervous system with the formation of underlying disorders prevailed in the cesarean-born children. By the age of 1 year, dysfunctions of the brain regulatory systems were more often observed in the cesarean-born children compared to the vaginally-born children (77.9% vs. 63.7%, p=0.000), and the result of the long-term autonomic imbalance was a higher frequency of cardiac arrhythmias (27.9% vs. 18.3%, p=0.017). Conclusion. The negative factors of the perinatal period, including cesarean delivery, adversely affect the severity and duration of autonomic imbalance with reduced sympathetic activitity against the background of dysfunctions of the brain regulatory systems.
Keywords: autonomic regulation, newborns, caesarean section, hypoxia, heart rate variability, electroencephalography
There is no conflict of interest.
Contact details of the corresponding author:
Tat'yana S. Tumaeva
tstumaeva@mail.ru
Received 25.12.2018
For citation:
Tumaeva T.S., Celkovich L.S., Naumenko E.I., Samoshkina E.S., Garina S.V., Vereshchagina V.S., Shirokova A.A. Peculiarities of autonomic regulation in infants who suffered from intrauterine hypoxia during different ways of delivery. Vestn. Ural. Med. Akad. Nauki. = Journal of Ural Medical Academic Science. 2018, Vol. 15, no. 6, pp. 814–823. DOI: 10.22138/2500-0918-2018-15-6-814-823 (In Russ).
REFERENCES
1. Thompson L.P., Crimmins S., Telugu B.P., Turan S. Intrauterine hypoxia: clinical consequences and therapeutic perspectives. Research and Reports in Neonatology. 2015. No. 5. pp. 79–89.
2. Orazmuradov А.А., Lukaev А.А., Yanin V.A., Lukaev A.A. Outcomes of premature birth in women having high factors for perinatal risks. International Journal of BioMedicine. 2014. No. 4 (1). pp. 32-35.
3. Liu J., Cao H.Y., Wang H.W., Kong X.Y. The role of lung ultrasound in diagnosis of respiratory distress syndrome in newborn infants. Iran J Pediatr. 2015; 25 (1): e323.
4. Huang J.T., Huang J.T., Kong X.Y. Analysis of related factors of extremely preterm infants'abnormal neurological findings. Zhonghua Er Ke Za Zhi. 2016. No. 54 (1). pp. 23-27.
5. Levine T.A., Grunau R.E., McAuliffe F.M., Alderdice F. Early childhood neurodevelopment after intrauterine growth restriction: a systematic review. Pediatrics. 2015. No. 135 (1). pp. 126-141.
6. Hayakawa M., Ito Y., Saito S. Incidence and prediction of outcome in hypoxic-ischaemic encephalopathy in Japan. Pediatrics International. 2014. No. 56. pp. 215-221.
7. Ye J., Zhang J., Mikolajczyk R., Betrán A.P. Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data. BJOG. 2016. No. 123 (5). pp. 745–753.
8. Markaryan N.M., Golikova T.P., Esipova L.N. Cesarean section. Unsolved issues. Bulletin of RUDN. Series: Medicine = Vestnik RUDN. Seriya: Medicina. 2016. No. 2. pp. 143-149. (In Russ)
9. Plevani C. Incerti M., Del Sorbo D., Pintucci A., Vergani P., Merlino L. et al. Cesarean delivery rates and obstetric culture – an Italian register-based study. AOGS. 2017. No. 96 (3). pp. 359–365.
10. Morozova A.Yu., Milyutina Yu.P., Arutyunyan A.V., Evsyukova I.I. The content of neurospecific enolase and neurotrophic growth factor in the cord blood of healthy full-term newborns after elective planned cesarean section surgery and spontaneous delivery. Journal of Obstetrics and Women's Diseases = Zhurnal akusherstva i zhenskih boleznej. 2015; LХIV (6): 38-42. (In Russ)
11. Radouani M.A., Chahid N., Kharbach A., Radouani M., Chahid N., Kharbach A. et al. Influence of mode of delivery on the stress response in infants. Psychology. 2015. No. 6. pp. 1861-1872.
12. Zamzami T.Y.Y., Al-Saedi S.A., Marzouki A.M., Nasrat H.A. Prediction of perinatal hypoxic encephalopathy: proximal risk factors and short-term complications. J. Clin. Gynecol. Obstet. 2014. No. 3 (3). pp. 97-104.
13. Yerushalmy-Fel A., Marom R., Peylan T., Korn A. Electroencephalographic characteristics in preterm infants born with intrauterine growth restriction. J. Pediatr. 2014. No. 164 (4). pp. 756-761.
14. Ivanov D.O., Kozlova L.V., Derevcov V.V. Vegetative disfunction and adaptive reserve potential in children born with fetus growth delay. Pediatrics = Pediatriya. 2017; 8 (2): 15-23. (In Russ)
15. Smith S.L., Lux R., Haley S., Slater H., Beachy J., Beechy J. et al. The effect of massage on heart rate variability in preterm infants. J Perinatol. 2013. No. 33 (1). pp. 59-64.
16. Zimmerman E., Thompson K. A Pilot Study: The role of the autonomic nervous system in cardiorespiratory regulation in infant feeding. Acta Paediatrica. 2015. No. 105 (3). pp. 286-291.
17. Makarov L.M. Holter monitoring. 4th ed. M .: PH “MEDPRAKTIKA-M” [M.: ID “MEDPRAKTIKA-M”], 2017. (In Russ).
18. Stroganova T.A., Degtyareva M.G., Volodin N.N. Electroencephalography in neonatology. M.: GEOTAR-Media [M.: GEOTAR-Media], 2005. (In Russ)
19. Molina G., Weiser T., Lipsitz R. Relationship between cesarean delivery rate and maternal and neonatal mortality. JAMA. 2015. No. 314 (21). pp. 2263–2279.
20. Prefumo F., Ferrazzi E., Tommaso M.D., Severi F.M. Neonatal morbidity after cesarean section before labor at 34(+0) to 38(+6) weeks: a cohort study. J Matern Fetal Neonatal Med. 2016. No. 29 (8). pp. 1334-1338.
21. Roescher A.M., Timmer A., Erwich J.J., Bos A.F. Placental pathology, perinatal death, neonatal outcome, and neurological development: a systematic review. PLoS One. 2014; 9 (2): URL: http://dx.doi.org/10.1371/journal.pone.008941.
22. Sun X., Crawford R., Liu C., Luo T., Hu B. Development-dependent regulation of molecular chaperones after hypoxia-ischemia. Neurobiol Dis. 2015. No. 82. pp. 123-31.
23. Goel A., Maski M.R., Bajracharya S., Wenger J.B., Zhang D., Salahuddin S. et al. Epidemiology and mechanisms of de novo and persistent hypertension in the postpartum period. Circulation. 2015. No. 132 (18). pp. 1726-1733.
24. Radha K., Prameela D.G., Manjula R.V., Chandrasekharan P.A. Study on rising trends of caesarean section (C-Section): a bio-sociological effect. IOSR. 2015. No. 14 (8 Ver. II). pp. 10-13.
25. Werner E.F., Han C.S., Savitz D.A., Goldshore M., Lipkind H.S. Health outcomes for vaginal compared with cesarean delivery of appropriately grown preterm neonates. Obstet Gynecol. 2013. No. 6. pp. 1195-1200.
26. Doan E., Gibbons K., Tudehope D. The timing of elective caesarean deliveries and early neonatal outcomes in singletion infants born 37-41 week’s gestation. Australian and New Zealand J. Obstet Gynecol. 2014. No. 54. pp. 340-347.
27. Fyfe K.L., Yiallourou S.R., Wong F.Y., Horne R.S.C. The development of cardiovascular and cerebral vascular control in preterm infants. Sleep Medicine Reviews. 2014. No. 18 (4). pp. 299–310.
28. Zimmerman E., Thompson K. A Pilot Study: The role of the autonomic nervous system in cardiorespiratory regulation in infant feeding. Acta Paediatrica. 2015. No. 105 (3). pp. 286-291.
Authors:
Tatyana S. Tumaeva
Cand. Sci. (Med.), Functional Diagnostics Вoctor
Mordovia Republican Central Clinical Hospital
Pobedy Str. 14/5, Saransk, Russian Federation, 430001 tstumaeva@mail.ru
Lyudmila S. Celkovich
Dr. Sci. (Med.), Professor, Head of the Department of Obstetrics and Gynecology No. 2
Samara State Medical University
Venceka Str. 69, Samara, Russian Federation, 443070 samaraobsgyn2@yandex.ru
Elena I. Naumenko
Cand. Sci. (Med.), Associate Professor of the Department
of Pediatrics
N.P. Ogarev Mordovia State University, Saransk
Ulyanova Str. 26A, Saransk, Russian Federation, 430032 ei-naumenko@yandex.ru
Elena S. Samoshkina
Cand. Sci. (Med.), Associate Professor of the Department
of Pediatrics
N.P. Ogarev Mordovia State University, Saransk
Ulyanova Str. 26A, Saransk, Russian Federation, 430032 esamoshkina@yandex.ru
Svetlana V. Garina
Cand. Sci. (Med.), Associate Professor of the Department
of Pediatrics
N.P. Ogarev Mordovia State University, Saransk
Ulyanova Str. 26A, Saransk, Russian Federation, 430032 astra-svet@rambler.ru
Veronika S. Vereshchagina
Cand. Sci. (Med.), Associate Professor of the Department
of Pediatrics
N.P. Ogarev Mordovia State University, Saransk
Ulyanova Str. 26A, Saransk, Russian Federation, 430032 doctor@is.mrsu.ru
Anastasiya A. Shirokova
Postgraduate Student of the Department of Pediatrics
N.P. Ogarev Mordovia State University, Saransk
Ulyanova Str. 26A, Saransk, Russian Federation, 430032 doctor@is.mrsu.ru
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)