{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T23:25:51Z","timestamp":1787354751645,"version":"build-2736575974"},"reference-count":48,"publisher":"Georg Thieme Verlag KG","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["T32-HD-098066-05S1"],"award-info":[{"award-number":["T32-HD-098066-05S1"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health & Human Development","doi-asserted-by":"crossref","award":["R01-HD099393"],"award-info":[{"award-number":["R01-HD099393"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>NeoNatal Neurobehavioral Scale (NNNS-II) measures behavioral signs of stress according to systems, including the autonomic and central nervous systems. These systems influence heart rate variability (HRV), which is a biomarker for regulatory capacity. The present study aims to investigate whether patterns of autonomic dysregulation are evident in both behavioral and physiological measures.<\/jats:p>\n                  <jats:p>HRV metrics\u2014short- and long-term fractal scaling exponents (\u03b11, \u03b12) and root mean square fluctuations (RMS1, RMS2)\u2014were calculated from the heart rates of 51 preterm infants at 33 weeks postmenstrual age. The NNNS-II assessments were conducted at term-equivalent age.<\/jats:p>\n                  <jats:p>Linear regression revealed that higher total stress signs were associated with increased \u03b12 (\u03b2\u2009=\u20090.366, p\u2009=\u20090.006), indicating reduced long-scale autonomic complexity. Autonomic and central nervous systems\u2013specific stress signs were significantly associated with elevated \u03b12 (\u03b2\u2009=\u20090.349, p\u2009=\u20090.022). Individual items such as high-frequency tremors were also associated with increased \u03b12 (\u03b2\u2009=\u20090.303, p\u2009=\u20090.018) whereas startles were not (p\u2009=\u20090.096).<\/jats:p>\n                  <jats:p>Neurobehavioral stress signs, particularly those associated with the central nervous system (CNS), are linked to early diminished autonomic variation in infants. These findings can help researchers and clinicians interpret the significance of neurobehavioral stress signs to autonomic tone in preterm infants.<\/jats:p>","DOI":"10.1055\/a-2938-3671","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T23:14:43Z","timestamp":1786749283000},"source":"Crossref","is-referenced-by-count":0,"title":["Neurobehavioral Stress Linked to the Central Nervous System is Associated with Heart Rate Variability Differences in Preterm Infants"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2854-0899","authenticated-orcid":false,"given":"Elan L.","family":"Donnellan","sequence":"additional","affiliation":[{"name":"Developing Brain Institute, Children's National Hospital, District of Columbia, United States","place":["Washington"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6208-1331","authenticated-orcid":false,"given":"Julius S.","family":"Ngwa","sequence":"additional","affiliation":[{"name":"Developing Brain Institute, Children's National Hospital, District of Columbia, United States","place":["Washington"]},{"name":"The George Washington University School of Medicine, District of Columbia, United States","place":["Washington"],"department":["Department of Pediatrics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6812-7898","authenticated-orcid":false,"given":"Nickie Niforatos","family":"Andescavage","sequence":"additional","affiliation":[{"name":"Developing Brain Institute, Children's National Hospital, District of Columbia, United States","place":["Washington"]},{"name":"The George Washington University School of Medicine, District of Columbia, United States","place":["Washington"],"department":["Department of Pediatrics"]},{"name":"Children's National Hospital, District of Columbia, United States","place":["Washington"],"department":["Division of Neonatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7672-7650","authenticated-orcid":false,"given":"Melissa O.","family":"Liggett","sequence":"additional","affiliation":[{"name":"Children's National Hospital, United States","place":["Washington"],"department":["Child Development Program"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1735-0069","authenticated-orcid":false,"given":"Catherine","family":"Limperopoulos","sequence":"additional","affiliation":[{"name":"Developing Brain Institute, Children's National Hospital, District of Columbia, United States","place":["Washington"]},{"name":"The George Washington University School of Medicine, District of Columbia, United States","place":["Washington"],"department":["Department of Pediatrics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3144-8791","authenticated-orcid":false,"given":"Adre J.","family":"du Plessis","sequence":"additional","affiliation":[{"name":"The George Washington University School of Medicine, District of Columbia, United States","place":["Washington"],"department":["Department of Pediatrics"]},{"name":"The Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, District of Columbia, United States","place":["Washington"]},{"name":"School of Medicine and Health Sciences, The George Washington University, District of Columbia, United States","place":["Washington"],"department":["Department of Neurology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9149-332X","authenticated-orcid":false,"given":"Rathinaswamy B.","family":"Govindan","sequence":"additional","affiliation":[{"name":"The George Washington University School of 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