Author:
Christoffel Kelsey,De Asis-Cruz Josepheen,Govindan Rathinaswamy B.,Kim Jung Hoon,Cook Kevin Michael,Kapse Kushal,Andescavage Nickie,Basu Sudeepta,Spoehr Emma,Limperopoulos Catherine,du Plessis Adre
Abstract
<b><i>Introduction:</i></b> The Central Autonomic Network (CAN) is a hierarchy of brain structures that collectively influence cardiac autonomic input, mediating the majority of brain-heart interactions, but has never been studied in premature neonates. In this study, we use heart rate variability (HRV), which has been described as the “primary output” of the CAN, and resting-state functional MRI (rsfMRI) to characterize brain-heart relationships in premature neonates. <b><i>Methods:</i></b> We studied premature neonates who underwent rsfMRI at term (37-week postmenstrual age or above) and had HRV data recorded during the same week of their MRI. HRV was derived from continuous electrocardiogram data during the week of the rsfMRI scan. For rsfMRI, a seed-based approach was used to define regions of interest (ROIs) pertinent to the CAN, and blood oxygen level-dependent signal was correlated between each ROI as a measure of functional connectivity. HRV was correlated with CAN connectivity (CAN<sub>conn</sub>) for each region, and subgroup analysis was performed based on sex and clinical comorbidities. <b><i>Results:</i></b> Forty-seven premature neonates were included in this study, with a mean gestational age at birth of 28.1 +/− 2.6 weeks. Term CAN<sub>conn</sub> was found to be significantly correlated with HRV in approximately one-fifth of CAN connections. Two distinct patterns emerged among these HRV-CAN<sub>conn</sub> relationships. In the first, increased HRV was associated with stronger CAN<sub>conn</sub> of limbic regions. In the second pattern, stronger CAN<sub>conn</sub> at the precuneus was associated with impaired HRV maturation. These patterns were especially pronounced in male premature neonates. <b><i>Conclusion:</i></b> We report for the first time evidence of brain-heart relationships in premature neonates and an emerging CAN, most striking in male neonates, suggesting that the brain-heart axis may be more vulnerable in male premature neonates. Signatures in the heart rate may eventually become an important noninvasive tool to identify premature males at highest risk for neurodevelopmental impairment.