Evidence map›Paper›PMID 42168534›Full record

ArticlePediatric research2026

Assessment of parasympathetic tone during therapeutic hypothermia in infants with brain injury following neonatal encephalopathy.

John Sunwoo, Sara Cherkerzian, Seh Hyun Kim, Katie Hannon, Aisling Garvey, Eniko Szakmar, Chelsea Munster, Hoda El-Shibiny, Helen Christou, Terrie E Inder and 2 more

Abstract read
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Article in Pediatric research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. ECI biocommentary: John Sunwoo.Pediatric research · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

John SunwooAthinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. jsunwoo@mgh.harvard.edu.
Sara CherkerzianDepartment of Pediatrics, Mass General Brigham for Children, Harvard Medical School, Boston, MA, USA.
Seh Hyun KimDepartment of Pediatrics, Mass General Brigham for Children, Harvard Medical School, Boston, MA, USA.
Katie HannonDepartment of Pediatrics, Mass General Brigham for Children, Harvard Medical School, Boston, MA, USA.
Aisling GarveyDepartment of Pediatrics, Mass General Brigham for Children, Harvard Medical School, Boston, MA, USA.
Eniko SzakmarDepartment of Pediatrics, Mass General Brigham for Children, Harvard Medical School, Boston, MA, USA.
Chelsea MunsterDepartment of Pediatrics, Mass General Brigham for Children, Harvard Medical School, Boston, MA, USA.
Hoda El-ShibinyDepartment of Pediatrics, Mass General Brigham for Children, Harvard Medical School, Boston, MA, USA.
Helen ChristouDepartment of Pediatrics, Mass General Brigham for Children, Harvard Medical School, Boston, MA, USA.
Terrie E InderDepartment of Pediatrics, Mass General Brigham for Children, Harvard Medical School, Boston, MA, USA.
Maria Angela FranceschiniAthinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Mohamed El-DibDepartment of Pediatrics, Mass General Brigham for Children, Harvard Medical School, Boston, MA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundNeonatal encephalopathy remains the leading cause of acquired brain injury in term infants. While therapeutic hypothermia (TH) has significantly improved outcomes in moderate to severe cases, many infants continue to experience long-term morbidity. Early, non-invasive biomarkers are needed to better identify infants at risk. This study assessed changes in high-frequency heart rate variability (HF-HRV), reflecting parasympathetic tone, during TH and rewarming.

methodsThis prospective, observational study analyzed electrocardiograms from infants during TH and rewarming. Brain injury was determined post-TH using an MRI-based standardized scoring system. Differences in trajectories of HRV and heart rate during TH and rewarming, by post-TH brain-injury status, were analyzed using linear mixed models.

resultsAmong thirty-nine infants, five (13%) were identified as having brain injury. HF-HRV increased over time during TH in both groups (p < 0.0001). However, the brain injury group exhibited consistently lower HF-HRV (p = 0.011) and higher heart rates (p = 0.008) compared to those without brain injury, indicating diminished parasympathetic tone.

conclusionDespite similar trends, the blunted HF-HRV response observed in the brain injury group highlights its potential utility as a non-invasive biomarker for identifying and monitoring infants at higher risk for adverse outcomes. IMPACT: Infants undergoing therapeutic hypothermia (TH) for neonatal encephalopathy demonstrated a progressive increase in high-frequency heart rate variability (HF-HRV) throughout TH. Compared to infants without brain injury, those with signs of brain injury on post-TH MRI had lower HF-HRV and higher heart rates during both cooling and rewarming phases. Our results suggest a gradual increase in parasympathetic tone during TH, as indicated by increasing HF-HRV in both groups, although it remained lower in the brain injury group. This is one of the few studies reporting a comparative analysis of HRV changes during TH in infants with potential brain injury.

Identifiers

PMID42168534

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.