Computerized vital signs analysis and late onset infections in extremely low gestational age infants

Abstract

The RALIS algorithm is a sensitive indicator for early detection of infection in preterm infants. Further modifications to improve the specificity of the algorithm are needed prior to application of VS modeling to patient antibiotic treatment decisions.

Vital signs analysis algorithm detects inflammatory response in premature infants with late onset sepsis and necrotizing enterocolitis

“…RALIS is a mathematical algorithm developed for monitoring of preterm infants to detect inflammatory response, such as in LOS. As previously described, VS data incorporated into RALIS include: heart rate, respiratory rate, temperature, desaturation events, and bradycardia events (19). The heart rate, respiratory rate, and temperature values are numerical, while the low SpO2 (oxygen saturation) and bradycardic inputs are binary, indicating the presence or absence of events during the preceding 2-3 hour interval.…”

“…The RALIS software was the first to incorporate multiple vital signs monitoring into a predictive algorithm to detect systemic inflammatory responses including LOS (24,25). As we previously reported, RALIS detected sepsis 2.5 days prior to clinician suspicion of infection (defined as the time blood culture was obtained) with a sensitivity of 82% for LOS in infants ≤28 weeks gestational age (GA) (19). However, the PPV and negative predictive value (NPV) were only 67% and 65% respectively.…”

“…Thus, development of more reliable and specific methods to predict and exclude LOS and/or NEC in preterm infants is essential to improve neonatal outcomes.The advantages of automated vital signs monitoring as an objective tool to detect evolving sepsis is being increasingly recognized (16,17). Several studies have suggested that analysis of vital signs patterns can help clinicians evaluate for impending infection or inflammatory response (e.g., sepsis, NEC) prior to obvious deterioration (18)(19)(20)(21). For example, the HeRO monitoring system detects heart rate variability characteristics that change with LOS.…”

“…A RALIS score ≥5 for 6 consecutive hours generates an alert to the clinical team. We limited our analysis to LOS and NEC episodes within 3-28 days of life for consistency and comparison with previous studies (19,25). A RALIS alert was considered associated with a LOS or NEC episode if it occurred within 7 days before or after infection was suspected.…”

Preventing preterm birth

“…There is a study of vertical transmission of cytomegalovirus through breast milk and the means for preventing it [1]. Another offers us an algorithm helpful in early detection of an infection in premature infants, and an effort to prevent its progression [2]. The third describes a drug treatment of emerging retinopathy of prematurity [3].…”