Abnormal heart rate characteristics before clinical diagnosis of necrotizing enterocolitis

Abstract

ObjectiveEarlier diagnosis and treatment of necrotizing enterocolitis (NEC) in preterm infants, prior to clinical deterioration, might improve outcomes. A monitor that measures abnormal heart rate characteristics (HRC) of decreased variability and repetitive decelerations was developed as an early warning system for sepsis. Since NEC shares pathophysiologic features with sepsis, we tested the hypothesis that abnormal HRC occur prior to clinical diagnosis of NEC.Study DesignRetrospective review of Bells stage II to III NEC cases among infants <34 weeks gestation enrolled in a prospective randomized clinical trial of HRC monitoring at 3 neonatal intensive care units.ResultsOf 97 infants with NEC and HRC data, 33 underwent surgical intervention within one week of diagnosis. The baseline HRC index from 1 to 3 days before diagnosis was higher in patients who developed surgical versus medical NEC (2.06 ± 1.98 vs. 1.22 ± 1.10, p=0.009). The HRC index increased significantly 16 hours prior to the clinical diagnosis of surgical NEC and 6 hours prior to medical NEC. At the time of clinical diagnosis, the HRC index was higher in patients with surgical versus medical NEC (3.3 ± 2.2 vs 1.9 ± 1.7, p<0.001).ConclusionsAbnormal HRC occur before clinical diagnosis of NEC, suggesting that continuous HRC monitoring may facilitate earlier detection and treatment.

Does heart rate variability reflect the systemic inflammatory response in a fetal sheep model of lipopolysaccharide-induced sepsis?

“…FHR and fHRV are regulated by a complex interplay of the parasympathetic and sympathetic nervous systems accounting for the baseline FHR as well as short-term and long-term fHRV showing linear and nonlinear properties (Frasch et al 2009). These fHRV properties are differentially affected by LPS-induced fetal and neonatal inflammatory response (Lake et al 2002, Stone et al 2013. Decreased fetal and neonatal HRV and transient repetitive heart rate decelerations coincide with or precede clinical signs of sepsis (Rudolph et al 1965, Cabal et al 1980, Fairchild and O'Shea 2010.…”

Current Research on the Epidemiology, Pathogenesis, and Management of Necrotizing Enterocolitis

“…Some neonatal units are now incorporating sophisticated analysis algorithms into their bedside monitoring, and ultimately these may provide just such a prediction tool. Abnormal heart rate characteristics have been suggested as a useful clinical tool to predict sepsis [25], and have shown initial promise to predict NEC before clinical diagnosis in a prospective trial setting [26]. However, a more recent study in which the same system was used in routine clinical practice suggested that abnormal heart rate characteristics have limited ability to detect sepsis [27].…”

Necrotizing Enterocolitis: A Narrative Review of Updated Therapeutic and Preventive Interventions

“…Neonates may experience abdominal distention with or without overlying skin changes, feeding intolerance/emesis, decreased or absent bowel sounds, increased pre-feeding gastric residuals, and blood in the stool. Other more systemic symptoms include hypotension, poor perfusion, increased bradycardic or apneic events, worsening respiratory status, glucose instability, abnormal heart rate, and temperature instability (1,2,14).…”