Neonatal pre-discharge heart rate variability and neurodevelopmental outcomes at 1- and 5-years in children with transposition of the great arteries

Abstract Background Children with congenital heart disease (CHD) are at increased risk for long-term neurodevelopmental impairment, yet reliable pre-discharge biomarkers are lacking. Heart rate variability (HRV), a non-invasive measure of autonomic regulation, has been proposed as a potential predictor. Methods In This retrospective cohort study (2015–2024), 58 infants with transposition of the great arteries (TGA) who underwent 24-h Holter electrocardiogram (ECG) before discharge. HRV time domain metrics were calculated by segmented 10 min epochs and summarized and neurodevelopment assessed at 1 year ( n  = 55) and at 5 years ( n  = 21). Were analyzed using Pearson correlations and multivariable linear regression adjusting for cardiopulmonary bypass (CPB) time, postnatal age at ECG, socioeconomic status, and hospital stay. Results Neonatal HRV was not independently associated with cognitive, language, or motor outcomes at either follow up. Exploratory bivariate analyses showed a weak, non-significant negative correlation between vagally mediated HRV and visual motor integration at 5 years. Longer CPB time and lower socioeconomic status were independent predictors of poorer neurodevelopment. Conclusion Neonatal pre-discharge HRV is not a reliable predictor for neurodevelopment at 1 or 5 years in children with TGA, highlighting the importance of perioperative complexity and socioeconomic factors. Multimodal longitudinal assessments are needed to better understand brain heart interaction in CHD. Impact First study to longitudinally assess associations between neonatal HRV and neurodevelopmental outcomes at 1 and 5 years in children with TGA. Neonatal pre-discharge HRV is not independently associated with later developmental outcomes at 1 and 5 years in children with TGA. Single pre discharge HRV measurements should be interpreted cautiously, longitudinal and multimodal assessments are likely needed to identify neurodevelopmental risk in CHD.