{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T09:28:41Z","timestamp":1786958921104,"version":"build-2736575974"},"reference-count":17,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T00:00:00Z","timestamp":1786752000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Introduction: We retrospectively assessed preoperative cardiac autonomic regulation in neonates with TGA who subsequently underwent arterial switch operation. Materials and Methods: Neonates treated between 1 January and 31 December 2024 were studied. Heart rate variability was derived from continuous ECG recordings, with low-frequency and high-frequency spectral components calculated from RR intervals. Longitudinal associations between HRV indices and the interval to surgery were evaluated using linear mixed-effects models with adjustment for relevant clinical covariates. Results: Twenty neonates were included. The median age at ASO was 7 days (IQR 5\u20139), median weight was 3100 g (IQR 2900\u20133400), and median preoperative oxygen saturation was 76% (IQR 70\u201382%). Balloon atrial septostomy had been performed in 10 patients. HRV data represented 150 patient-days of monitoring. In unadjusted analyses, both LF and HF power declined as surgery was delayed, with the strongest association observed for HF power. In the adjusted mixed-effects model, longer time to surgery remained independently associated with lower HF power (\u03b2 = \u22120.07, 95% CI \u22120.129 to \u22120.011, p = 0.03). Conclusions: Serial HF measurements may reflect progressive changes in autonomic regulation during the preoperative period in neonates with TGA.<\/jats:p>","DOI":"10.3390\/children13081085","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T08:05:41Z","timestamp":1786953941000},"page":"1085","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative Heart Rate Variability and Parasympathetic Modulation in Newborns with Transposition of the Great Arteries Undergoing Arterial Switch Operation"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5270-4294","authenticated-orcid":false,"given":"Dilek Yavuzcan","family":"\u00d6zt\u00fcrk","sequence":"first","affiliation":[{"name":"Department of Neonatology, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, 34003 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0727-4875","authenticated-orcid":false,"given":"Demet","family":"O\u011fuz","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, 34003 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7673-2855","authenticated-orcid":false,"given":"\u015eenay","family":"\u00c7oban","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, 34003 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1762-3269","authenticated-orcid":false,"given":"Erkut","family":"\u00d6zt\u00fcrk","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, 34003 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/ejcts\/ezw360","article-title":"Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum","volume":"51","author":"Sarris","year":"2017","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1111\/chd.12295","article-title":"Impact of Coronary Artery Anatomy in Arterial Switch Procedure on Early Mortality and Morbidity","volume":"11","author":"Altin","year":"2016","journal-title":"Congenit. Heart Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1017\/S1047951110000296","article-title":"Analysis of 8681 neonates with transposition of the great arteries: Outcomes with and without Rashkind balloon atrial septostomy","volume":"20","author":"Mukherjee","year":"2010","journal-title":"Cardiol. Young"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"59","DOI":"10.4274\/csmedj.galenos.2022.2022-5-1","article-title":"Evaluation of the Adequacy of Blood Mixing by Echocardiographic Parameters in Neonates with the Transposition of Great Arteries","volume":"2","year":"2022","journal-title":"Cam Sakura Med. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"106165","DOI":"10.1016\/j.earlhumdev.2024.106165","article-title":"Preoperative autonomic failure in neonates with critical congenital heart disease","volume":"200","author":"Govindan","year":"2025","journal-title":"Early Hum. Dev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1161\/01.CIR.93.5.1043","article-title":"Heart Rate Variability: Standards of Measurement, Physiological Interpretation, and Clinical Use","volume":"93","author":"Camm","year":"1996","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1016\/j.jpeds.2011.08.049","article-title":"Heart rate characteristic monitoring-HeRO or villain?","volume":"159","author":"Groves","year":"2011","journal-title":"J. Pediatr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1038\/sj.jp.7211861","article-title":"Clinical reliability and validity of the N-PASS: Neonatal pain, agitation and sedation scale with prolonged pain","volume":"28","author":"Hummel","year":"2008","journal-title":"J. Perinatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1184","DOI":"10.1007\/s00134-012-2544-x","article-title":"Prospective validation of the vasoactive-inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery","volume":"38","author":"Davidson","year":"2012","journal-title":"Intensive Care Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2001","DOI":"10.1016\/j.compbiomed.2013.09.019","article-title":"Mitigating the effect of non-stationarity in spectral analysis-an appli-cation to neonate heart rate analysis","volume":"43","author":"Govindan","year":"2013","journal-title":"Comput. Biol. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s10286-019-00616-w","article-title":"Heart rate variability is depressed in the early transitional period for newborns with complex congenital heart disease","volume":"30","author":"Mulkey","year":"2020","journal-title":"Clin. Auton. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1016\/j.jpeds.2013.11.038","article-title":"Infection and other clinical correlates of abnormal heart rate characteristics in preterm infants","volume":"164","author":"Sullivan","year":"2014","journal-title":"J. Pediatr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1055\/s-0038-1639339","article-title":"Changes in Autonomic Tone in Premature Infants Developing Necrotizing Enterocolitis","volume":"35","author":"Reich","year":"2018","journal-title":"Am. J. Perinatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1038\/s41372-023-01754-w","article-title":"Prediction of outcome of hypox-ic-ischemic encephalopathy in newborns undergoing therapeutic hypothermia using heart rate variability","volume":"44","author":"Presacco","year":"2024","journal-title":"J. Perinatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.earlhumdev.2014.12.016","article-title":"Autonomic regulation in fetuses with congenital heart disease","volume":"91","author":"Siddiqui","year":"2015","journal-title":"Early Hum. Dev."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Fairchild, K.D. (2026). Depressed heart rate variability predicts adverse neonatal events and outcomes, with important caveats. Pediatr. Res.","DOI":"10.1038\/s41390-026-04897-6"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Somasundaram, V., Liamlahi, R., Berger, F., Balmer, C., Jost, K., and Hagmann, C. (2026). Neonatal pre-discharge heart rate variability and neurodevelopmental outcomes at 1- and 5-years in children with transposition of the great arteries. Pediatr. Res.","DOI":"10.1038\/s41390-026-05111-3"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/8\/1085\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T09:03:02Z","timestamp":1786957382000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/8\/1085"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,15]]},"references-count":17,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["children13081085"],"URL":"https:\/\/doi.org\/10.3390\/children13081085","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,15]]}}}