Heart rate variability as possible marker of brain damage in neonates with hypoxic ischemic encephalopathy: a systematic review

Eur J Pediatr. 2021 May;180(5):1335-1345. doi: 10.1007/s00431-020-03882-3. Epub 2020 Nov 27.


Heart rate variability (HRV) is currently considered the most valuable non-invasive test to investigate the autonomic nervous system function, based on the fact that fast fluctuations might specifically reflect changes of sympathetic and vagal activity. An association between abnormal values of HRV and brain impairment has been reported in the perinatal period, although data are still fragmentary. Considering such association, HRV has been suggested as a possible marker of brain damage also in case of hypoxic-ischemic encephalopathy following perinatal asphyxia. The aim of the present manuscript was to review systematically the current knowledge about the use of HRV as marker of cerebral injury in neonates suffering from hypoxic-ischemic encephalopathy. Findings reported in this paper were based on qualitative analysis of the reviewed data. Conclusion: A growing body of research supports the use of HRV as non-invasive, bedside tool for the monitoring of hypoxic-ischemic encephalopathy. The currently available data about the role of HRV as prognostic tool in case of hypoxic ischemic encephalopathy are promising but require further validation by future studies. What is Known: • Heart rate variability (HRV) is a non-invasive monitoring technique to assess the autonomic nervous system activity. • A correlation between abnormal HRV and cerebral injury has been reported in the perinatal period, and HRV has been suggested as possible marker of brain damage in case of hypoxic-ischemic encephalopathy. What is New: • HRV might provide precocious information about the entity of brain injury in asphyxiated neonates and be of help to design early, specific, and personalized treatments according to severity. • Further investigations are required to confirm these preliminary data.

Keywords: Asphyxia; Brain damage; Heart rate; Heart rate variability; Hypoxic ischemic encephalopathy; Neonate; Therapeutic hypothermia.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Asphyxia Neonatorum* / complications
  • Brain
  • Brain Injuries*
  • Female
  • Heart Rate
  • Humans
  • Hypoxia-Ischemia, Brain* / complications
  • Hypoxia-Ischemia, Brain* / diagnosis
  • Infant, Newborn
  • Pregnancy