In the neonatal intensive care unit (NICU), heart rate, respiratory rate, and oxygen saturation are vital signs (VS) that are continuously monitored in infants, while blood pressure is often monitored continuously immediately after birth, or during critical illness. Although changes in VS can reflect infant physiology or circadian rhythms, persistent deviations in absolute values or complex changes in variability can indicate acute or chronic pathology. Recent studies demonstrate that analysis of continuous VS trends can predict sepsis, necrotizing enterocolitis, brain injury, bronchopulmonary dysplasia, cardiorespiratory decompensation, and mortality. Subtle changes in continuous VS patterns may not be discerned even by experienced clinicians reviewing spot VS data or VS trends captured in the monitor. In contrast, objective analysis of continuous VS data can improve neonatal outcomes by allowing heightened vigilance or preemptive interventions. In this review, we provide an overview of the studies that have used continuous analysis of single or multiple VS, their interactions, and combined VS and clinical analytic tools, to predict or detect neonatal pathophysiology. We make the case that big-data analytics are promising, and with continued improvements, can become a powerful tool to mitigate neonatal diseases in the twenty-first century.

IMPORTANCE Infection in neonates remains a substantial problem. Advances for this population are hindered by the absence of a consensus definition for sepsis. In adults, the Sequential Organ Failure Assessment (SOFA) operationalizes mortality risk with infection and defines sepsis. The generalizability of the neonatal SOFA (nSOFA) for neonatal late-onset infection-related mortality remains unknown. OBJECTIVE To determine the generalizability of the nSOFA for neonatal late-onset infection-related mortality across multiple sites.

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Objective Identify clinical conditions associated with a large increase (spike) in the heart rate characteristics index in VLBW infants. Study design Retrospective medical record review within a day of all large heart rate characteristics index spikes (increase of ≥3 from prior 5 day average) in VLBW infants at a single center enrolled from 2007–2010 in a multicenter trial of heart rate characteristics monitoring. In the trial, infants were randomized to having their heart rate characteristics index displayed to clinicians or not displayed. Results Of 274 eligible infants, 224 large heart rate characteristics spikes occurred in 105 infants. Thirty-three spikes were associated with surgery or procedures requiring anesthetic or anticholinergic medications, and infection-related conditions were the most common clinical association with the other spikes. Of the first spikes in 47 infants randomized to conventional monitoring (heart rate characteristics index not displayed to clinicians), 53% were associated with suspected or proven infection. Respiratory deterioration without suspected infection occurred with 34%, and no association was identified in 13%. Infants randomized to having their heart rate characteristics index displayed were more likely to have antibiotics initiated around the time of a large heart rate characteristics index spike. Conclusions Sepsis, other infectious or systemic inflammatory conditions, respiratory deterioration, and surgical procedures are the most common clinical associations with a large increase in the heart rate characteristics index in VLBW infants. This information may improve use of heart rate characteristics monitors in NICU patients.

Objective Abnormal heart rate characteristics (HRC) of decreased variability and transient decelerations may occur in preterm infants with sepsis and other pathologic conditions. We sought to determine whether an early HRC index (HeRO score), measured in the first day and week after birth, predicts death and morbidities compared to established illness severity scores. Study Design For all very low birth weight infants in a single NICU from 2004–2014, the average first day HRC index was calculated within 24h of birth (aHRC-24h) and the average first week HRC index within 7 days of birth (aHRC-7d). The Score for Neonatal Acute Physiology (SNAP-II) and Clinical Risk Indicator for Babies (CRIB-II) were calculated when data were available. aHRC was compared to the Score for Neonatal Acute Physiology (SNAP-II) and Clinical Risk Indicator for Babies (CRIB-II) for predicting death, late onset septicemia (LOS), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage (sIVH), or severe retinopathy of prematurity (sROP). Results All four scores were associated with death and sIVH(p< 0.01). The odds ratio and 95% CI for every one-point increase in aHRC for predicting mortality, adjusted for GA, was 1.59(1.25, 2.00) for aHRC-24h and 2.61(1.58, 4.33) for aHRC-7d. High aHRC-7d, SNAP-II and CRIB-II were associated with BPD(p<0.001). High aHRC-7d was associated with LOS(p<0.05). None of the scores predicted NEC or sROP. Conclusion HRC assessed in the first day or first week after birth compares favorably to established risk scores to predict death and morbidities in VLBW infants.