测量心脏自主神经系统（ANS）活性的幼儿 - 安静和发展挑战
Summary
我们描述了与18个月大的孩子休息和挑战的条件下连续监测的自主神经系统的方法。结果表明，该协议能产生有意义的生理反应的自主神经系统的两个分支和响应模式引起显著的个体差异。
Abstract
自主神经系统（ANS）包括两个分支，副交感神经和交感神经系统，并控制内部器官（如心脏速率，呼吸，消化）的功能，并响应日常和不良事件1。已发现儿童ANS措施涉及到的行为问题，情绪调节和健康2-7。因此，幼儿期了解影响ANS发展的因素是很重要的。在ANS的两个分支影响青少年儿童对刺激心血管反应，并已测量无创性，通过外部监测设备，采用生理变化8-11有效和可靠的措施。不过，也有非常年幼的儿童与副交感神经和交感神经系统的同步措施，限制了两个系统的集成功能的了解一些研究。此外，Majori的现有幼儿的研究对婴幼儿休息ANS措施或者其反应报告TY常用的母子互动范例，而较少有人知道ANS反应到其他具有挑战性的条件。我们提出了一个研究设计和标准化的协议，用于心脏自主控制在18个月大的孩子一个非侵入性和快速评估。我们家庭或实验室访问期间描述了连续监测ANS的休息和挑战条件下，副交感神经和交感神经分支的方法，从我们的使用验证的设备和软件得分140种族多元化的幼儿提供样本描述调查结果。结果表明，该协议可能会产生一系列既休息和发育困难的条件下的生理反应，在心脏的变动和副交感神经和交感神经活动指数所示。个人休息的水平，respons证明变异ES挑战，挑战和反应性，它提供了额外的证据，该协议旨在为幼儿ANS个体差异考试有用。
Introduction
在孩子们的自主神经系统的个体差异（ANS）活性发挥的生理和心理健康问题12-16发展和维护具有重要作用。越来越多的证据体现出，在休息和反应性ANS措施个体差异预测儿童和外向精神病理学4,9,17-19和身体健康7,20的变化。除了ANS运作这些直接或主要作用，研究的积累的身体已经发现，孩子们的反应可以用上下文的危险因素，如不良事件或婚姻冲突，中度对儿童的福祉和健康的影响进行交互（见参考文献21复审）。尽管越来越多的证据，儿童的自主反应起到保健作用在整个生命过程中，在这些过程中伴随的兴趣，有是需要更多的研究三岁下检查ANS功能在儿童中的发展。
该ANS包括两个分支，副交感神经和交感神经系统。它调节内脏（如心脏速率，呼吸，消化，性兴奋）的功能，主要是通过无意识的机制，以应对日常和不良反应1。副交感神经系统（PNS）是“休息和恢复”的系统，睡觉或放松交感神经系统（SNS）时保持较低的休息心脏率和恢复状态是响应紧急情况或威胁“战斗或逃跑”系统通过加速一个人的心脏率23的情况。呼吸性窦性心律不齐（RSA）是对心脏功能的PNS影响的可靠指标，和射血前期（PEP）是对汽车在SNS影响的可靠指标DIAC工作。 RSA和PEP已经发现通过在成人24,25的样品的实验药理学阻断有效的措施。最近，这项工作已经扩展到儿童和青少年的样本，进一步确立了RSA和PEP在整个发展8,26,27 ANS活动的有效和可靠的措施。使用带和现场电极可靠心阻抗测量（PEP）已成人样本28被使用相当长的时间。最近，平行测量和分析技术也被证明是可靠的，并在儿童11,29,30的样本有效的，尽管在幼儿的PEP措施集合是罕见的。
有对PNS在婴幼儿，包括迷走神经张力和呼吸性窦性心律不齐措施发挥作用的现存的大量文献。有使用PEP的SNS的研究较少，很少同时检查这两个副交感神经和交感神经系统，这是建立自己的高度集成的功能的理解是至关重要的。幼儿PEP的一些研究中，大多数发现自己的协议不产生响应的挑战8.31的PEP显著集团层面的变化。有研究表明，有稳定搁在婴儿期开始PNS措施，他们与气质，行为和健康，13,16,26,32,33关系，但有SNS的理解有限响应和稳定性随着时间的推移，关系发展，塑造其发展轨迹的因素。 PNS响应已被主要归因于社会参与16和SNS的反应提出了体现“战斗或逃跑反应”1以及奖励灵敏度（见参考文献34复审）。在年幼的孩子，这是具有挑战性的，以模拟在laborato具体的挑战RY和他们搞由于他们的注意力持续时间短。还有谁可能感到不适与同时测量PNS与SNS需要七个点电极测量幼儿的挑战。此外，发展科学领域内，有关于如何激发“应激反应”，同时充分尊重也与儿童工作儿童的发展需求和职业道德标准很少。本文介绍了关于由设计引起从18个月大的孩子和副交感神经交感神经系统的反应休息和挑战性的环境的标准化协议的管理和评分信息。
ANS反应通常是概念化为离散相对于外部刺激的生理反应比较或休息状态，横跨生物个体差异22。的精神和肉体的生命早期病因的检查，他ALTH问题已导致科学家在理解孩子们的反应，以唤起自适应响应，或者可能被认为是紧张的情况下挑战特别感兴趣。文献的优势是指这种现象为“压力反应”，虽然在遇到挑战性的刺激具有在宽范围的域的引出应答的潜力。因此，协议中所述下方被设计为跨多个领域，包括两种形式的休息引起ANS反应（一边听着舒缓的摇篮曲，并同时观看了冷静，中立视频）和18个月的孩子3发育相适应的挑战：预测/惊吓（玩偶的箱），感官（柠檬汁），和社会情感（听一个生病的婴儿哭声的）。该协议是改编自我们现有的12个月孩子8和3-5岁儿童11协议，以使其发育挑战性，参与和容忍的幼儿（18-21个月）。
在这里，我们目前的发展挑战协议（DCP）和ANS从应力的18个月大的考察访问数据，进食和孕妇和他们的后代的早期发展（SEED）研究。健康孕妇怀孕期间参加了2013-14孕期体重增加和产前应激的研究中招募和超重，低收入，以及种族和多族裔。刚出生后并再次之前的数据收集为这里所报告的研究中，当后代是18-21个月的年龄时2014-2015的开始获得父母对她的后代的研究的知情同意。
Protocol
Representative Results
Discussion
这项研究表明，18个月大的孩子，标准化的休息和挑战任务，旨在从一系列域（惊吓，感官，社交，休息）的得到响应样品中导致了一系列的ANS响应。这些休息和挑战的条件下发现，平均ANS反应是类似于谁已经测量ANS的反应与使用类似的任务8,11,27,29幼儿人报道ANS值。在我们的样本中发现的ANS措施的平均水平是那些通常在婴幼儿发现和那些在年龄较大的儿童中发现，这是符合证据之间的心?…
Offenlegungen
The authors have nothing to disclose.
Acknowledgements
This research was supported by NIH 1 U01 HL097973, NHLBI 5 R01 HL116511-02, UCSF-CTSI Grant Number UL1 TR000004, the Robert Wood Johnson Health and Society Scholars Program, and the Lisa and John Pritzker Family Foundation. The authors also wish to acknowledge Michelle Stephens for her assistance with scoring the ANS data as well as Vanessa Tearnan, Marialma Gonzales-Cruz, Yurivia Cervantes, Amy Engler, Stephanie Grover and Karen Jones-Mason for their assistance in collecting the ANS data, and Michael Coccia for his help with the data. We are also thankful to the families for their generous participation in this research and to the volunteers who helped us to test and refine this protocol, including the first author’s two children. We want to acknowledge our mentors who taught us about measuring ANS and why measuring ANS responsivity is meaningful in young children: W. Thomas Boyce, Gary Bernston, and Dave Lozano.
Materials
| ANS equipment | |||
| Laptop and power cord | Dell | 60-0107-3.0 | Mindware BioLab software requires a PC with 2 USB ports |
| ANS data collection software | Mindware | contact company | BioLab acquisition program |
| ANS data acquisition unit and cords | Mindware | 50-3711-08 | BioNex 8-slot Chassis |
| Snap leads | Mindware | 93-0498-00 | 2 white, 2 red, 2 brown, 1 black |
| Spot electrodes | Kendall | 31112496 | 130 model; 7 for each assessment + extras-to be sealed in a ziplock bag at all times) |
| ANS scoring/editing software | Mindware | contact company | HRV Analysis, version 3.1.0F and IMP Analysis, version 3.1.0I |
| Protocol equipment | |||
| tablet computer | Apple | iPad; for playing audio and video clips | |
| portable speaker | Polariod | PBT510 | |
| Jack in the Box | Schylling | SMJB | Sock Monkey theme |
| Lemon juice | ReaLemon | 98077 | 0.14oz shelf-stable packets |
| Pasture pipettes | Grainger | 6FAV9 | 1 ml size, disposable |
| Portion cups | Dart Solo Con | 250PC | 2.5 oz, disposable, plastic |
| audio files of baby cry | Alkon lab | 30 second clip recorded in a neonatal intensive care unit | |
| audio file of baseline lullaby | Rockabye Baby Music | 60 seconds of "Across the Universe" on "Rockabye Baby Lullaby Renditions of the Beatles" CD | |
| audio file of final lullaby | Rockabye Baby Music | 60 seconds of "Here Comes the Sun" on "Rockabye Baby Lullaby Renditions of the Beatles" CD | |
| video file of neutral video | 2 minutes of Baby Einstein video | ||
| Retractable measuring tape | Rollfix | TM04 | |
| Miscellaneous materials | |||
| Surge protector | to plug in all electronics | ||
| 2-prong adapter for surge protector | |||
| Video camera | Sony | Handycam HDR-CX440 | |
| Video Encoder, power and input cords | Mindware | 50-8614-01 | optional; to sync video and ANS data files |
| Baby wipes and gauze | for cleaning and drying oily skin | ||
| Toys | to distract children during assessment | ||
| Visual aids | pictures of child with electrodes on, description of protocol to show participants | ||
| Script of protocol for research assistants | |||
| Charging cords for tablet and speaker | |||
| Doll and reinforcer | for demonstration if necessary |
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