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.

Preterm infants showed fewer desaturation events less than 85% during PR than prior to reading exposure. This effect persisted up to 1 h after reading exposure. Desaturation events were fewer with live and maternal PR. Voice exposure can be an important way for parents to participate in the care of their preterm infants.