Septicemia mortality reduction in neonates in a heart rate characteristics monitoring trial

Abstract

Background Abnormal heart rate characteristics (HRC) wax and wane in early stages of culture-positive, late-onset septicemia (LOS) in patients in the neonatal intensive care unit (NICU). Continuously monitoring an HRC index leads to a reduction in mortality among very low birth weight (VLBW) infants. We hypothesized that the reduction in mortality was due to a decrease in septicemia-associated mortality. Methods This is a secondary analysis of clinical and HRC data from 2989 VLBW infants enrolled in a randomized controlled trial of HRC monitoring in 9 NICUs from 2004–2010. Results LOS was diagnosed 974 times in 700 patients, and the incidence and distribution of organisms were similar in HRC display and non-display groups. Mortality within 30 days of LOS was lower in the HRC display compared to the non-display group (11.8% vs 19.6%, RR 0.61, 95% CI 0.43, 0.87, p<0.01), but mortality reduction was not statistically significant for patients without LOS. There were fewer large, abrupt increases in the HRC index in the days leading up to LOS diagnosis in infants whose HRC index was displayed. Conclusions Continuous HRC monitoring is associated with a lower septicemia-associated mortality in VLBW infants, possibly due to diagnosis earlier in the course of illness.

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

“…Based on this animal and human clinical perinatal body of evidence, we propose that developing longitudinal and comprehensive fHRV monitoring in a model of LPS-induced inflammation will allow us to build algorithms to improve early diagnosis of infection. Such monitoring would capture both linear and nonlinear fHRV properties, a strategy that has proven effective in septic adult and neonatal patients (Seely and Macklem 2004, Ahmad et al 2009, Fairchild et al 2013.…”

Evidence-based versus pathophysiology-based approach to diagnosis and treatment of neonatal cardiovascular compromise

“…Alternatively, it may lead to overdiagnosis and use of unnecessary cardiovascular support not without potential side-effects. A recent study showed that paying close attention to the output of the autonomic nervous system by continuously monitoring heart rate characteristics using the HeRO monitor may aid in early recognition of sepsis before progressing to shock [30]. Indeed, mortality rate was lower among neonates with sepsis whose HeRO scores were available to the clinicians (see B.A.…”

Hemodynamic monitoring of the critically ill neonate: An eye on the future

“…As an encouraging example of such efforts, the use of the heart rate characteristics monitoring system to identify neonates at risk for sepsis has been validated to decrease mortality from late onset neonatal sepsis [51,52] (see also B.A. Sullivan and K.D.…”