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Heart Rate Characteristic Index Monitoring for Early Detection of Infections in Very Low Birth Weight Infants

Received: 16 July 2019     Accepted: 13 August 2019     Published: 28 August 2019
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Abstract

The aim of this study is 1) to determine the sensitivity and specificity of continuous heart rate characteristics (HRC) monitoring in detection of infections and 2) to evaluate whether HRC monitoring detects infections prior to onset of clinical symptoms in very low birth weight (VLBW) infants. A retrospective cohort study was conducted analyzing HRC scores and episodes of infection for VLBW infants in the Neonatal Intensive Care Unit (NICU) at Cincinnati Children’s Hospital Medical Center from January 2015 through May 2016. HRC scores were acquired using the HRC monitor system and entered into the electronic medical record by bedside staff. Culture-positive and culture-negative clinical infections were recorded. Positive HRC scores were defined as an increase 1 point above the baseline or the first rise above 2. HRC scores within 24 hours and also within the 5-day period before the start of antibiotics for infections were analyzed for sensitivity, specificity, positive predictive value and negative predictive value for detection of neonatal infection. The HRC score increase 1 point above the baseline or the first rise above 2 in the 24 hours before the start of antibiotics for infectious events had a sensitivity of 68.0%, a specificity of 10.8%. Positive predictive value (PPV) and negative predictive value (NPV) were 34.0% and 33.3%, respectively. The PPV and NPV were modestly higher for elevated HRC scores during the 5-day period before infections, 41.1% and 66.7%, respectively. In our single-center retrospective study, elevated HRC scores had limited ability to detect infection. More than half of the positive monitor events were not related to infection. The potential clinical impact of the monitor to detect infection before the onset of clinical symptoms was limited and the risk for unnecessary evaluation and treatment was high.

Published in American Journal of Pediatrics (Volume 5, Issue 3)
DOI 10.11648/j.ajp.20190503.25
Page(s) 170-174
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

HeRO Monitor, Neonatal Infection, Sepsis

References
[1] Patel RM, Kandefer S, Walsh MC, et al. Causes and timing of death in extremely premature infants from 2000 through 2011. N Engl J Med. 2015; 372 (4): 331-340.
[2] Clapp DW. Developmental regulation of the immune system. Semin Perinatol. 2006; 30 (2): 69-72.
[3] Stoll BJ, Hansen N, Fanaroff AA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics. 2002; 110 (2 Pt 1): 285-291.
[4] Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J. 1996; 17 (3): 354-381.
[5] Vergales BD, Zanelli SA, Matsumoto JA, et al. Depressed heart rate variability is associated with abnormal EEG, MRI, and death in neonates with hypoxic ischemic encephalopathy. Am J Perinatol. 2014; 31 (10): 855-862.
[6] Verklan MT, Padhye NS. Heart rate variability as an indicator of outcome in congenital diaphragmatic hernia with and without ECMO support. J Perinatol. 2004; 24 (4): 247-251.
[7] Kovatchev BP, Farhy LS, Cao H, Griffin MP, Lake DE, Moorman JR. Sample asymmetry analysis of heart rate characteristics with application to neonatal sepsis and systemic inflammatory response syndrome. Pediatr Res. 2003; 54 (6): 892-898.
[8] Sullivan BA, Grice SM, Lake DE, Moorman JR, Fairchild KD. Infection and other clinical correlates of abnormal heart rate characteristics in preterm infants. J Pediatr. 2014; 164 (4): 775-780.
[9] Griffin MP, O'Shea TM, Bissonette EA, Harrell FE, Jr., Lake DE, Moorman JR. Abnormal heart rate characteristics preceding neonatal sepsis and sepsis-like illness. Pediatr Res. 2003; 53 (6): 920-926.
[10] Fairchild KD, Schelonka RL, Kaufman DA, et al. Septicemia mortality reduction in neonates in a heart rate characteristics monitoring trial. Pediatr Res. 2013; 74 (5): 570-575.
[11] Moorman JR, Carlo WA, Kattwinkel J, et al. Mortality reduction by heart rate characteristic monitoring in very low birth weight neonates: a randomized trial. J Pediatr. 2011; 159 (6): 900-906 e901.
[12] Lynema S, Marmer D, Hall ES, Meinzen-Derr J, Kingma PS. Neutrophil CD64 as a diagnostic marker of sepsis: impact on neonatal care. Am J Perinatol. 2015; 32 (4): 331-336.
[13] Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988; 16 (3): 128-140.
[14] Newcombe RG. Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med. 1998; 17 (8): 857-872.
[15] Griffin MP, Moorman JR. Toward the early diagnosis of neonatal sepsis and sepsis-like illness using novel heart rate analysis. Pediatrics. 2001; 107 (1): 97-104.
[16] Ellenby MS, McNames J, Lai S, et al. Uncoupling and recoupling of autonomic regulation of the heart beat in pediatric septic shock. Shock. 2001; 16 (4): 274-277.
[17] De Rogalski Landrot I, Roche F, Pichot V, et al. Autonomic nervous system activity in premature and full-term infants from theoretical term to 7 years. Auton Neurosci. 2007; 136 (1-2): 105-109.
[18] El-Lakany MA, Fouda MA, El-Gowelli HM, El-Gowilly SM, El-Mas MM. Gonadal hormone receptors underlie the resistance of female rats to inflammatory and cardiovascular complications of endotoxemia. Eur J Pharmacol. 2018; 823: 41-48.
[19] Chang YT, Huang WC, Cheng CC, et al. Effects of epinephrine on heart rate variability and cytokines in a rat sepsis model. Bosn J Basic Med Sci. 2018.
[20] Thungtong A, Knoch MF, Jacono FJ, Dick TE, Loparo KA. Periodicity: A Characteristic of Heart Rate Variability Modified by the Type of Mechanical Ventilation After Acute Lung Injury. Front Physiol. 2018; 9: 772.
[21] Binder S, Hill K, Meinzen-Derr J, Greenberg JM, Narendran V. Increasing VLBW deliveries at subspecialty perinatal centers via perinatal outreach. Pediatrics. 2011; 127 (3): 487-493.
[22] Wyckoff MH, Perlman JM. Effective ventilation and temperature control are vital to outborn resuscitation. Prehosp Emerg Care. 2004; 8 (2): 191-195.
[23] Koksal N, Baytan B, Bayram Y, Nacarkucuk E. Risk factors for intraventricular haemorrhage in very low birth weight infants. Indian J Pediatr. 2002; 69 (7): 561-564.
[24] Okuyama H, Ohfuji S, Hayakawa M, et al. Risk factors for surgical intestinal disorders in VLBW infants: Case-control study. Pediatr Int. 2016; 58 (1): 34-39.
[25] Fairchild KD, Lake DE, Kattwinkel J, et al. Vital signs and their cross-correlation in sepsis and NEC: a study of 1,065 very-low-birth-weight infants in two NICUs. Pediatr Res. 2017; 81 (2): 315-321.
[26] Badke CM, Marsillio LE, Weese-Mayer DE, Sanchez-Pinto LN. Autonomic Nervous System Dysfunction in Pediatric Sepsis. Front Pediatr. 2018; 6: 280.
Cite This Article
  • APA Style

    Denise Moreira, Kristin Melton, Jareen Meinzen-Derr, Meredith Tabangin, Paul Kingma, et al. (2019). Heart Rate Characteristic Index Monitoring for Early Detection of Infections in Very Low Birth Weight Infants. American Journal of Pediatrics, 5(3), 170-174. https://doi.org/10.11648/j.ajp.20190503.25

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    ACS Style

    Denise Moreira; Kristin Melton; Jareen Meinzen-Derr; Meredith Tabangin; Paul Kingma, et al. Heart Rate Characteristic Index Monitoring for Early Detection of Infections in Very Low Birth Weight Infants. Am. J. Pediatr. 2019, 5(3), 170-174. doi: 10.11648/j.ajp.20190503.25

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    AMA Style

    Denise Moreira, Kristin Melton, Jareen Meinzen-Derr, Meredith Tabangin, Paul Kingma, et al. Heart Rate Characteristic Index Monitoring for Early Detection of Infections in Very Low Birth Weight Infants. Am J Pediatr. 2019;5(3):170-174. doi: 10.11648/j.ajp.20190503.25

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  • @article{10.11648/j.ajp.20190503.25,
      author = {Denise Moreira and Kristin Melton and Jareen Meinzen-Derr and Meredith Tabangin and Paul Kingma and Kurt Schibler},
      title = {Heart Rate Characteristic Index Monitoring for Early Detection of Infections in Very Low Birth Weight Infants},
      journal = {American Journal of Pediatrics},
      volume = {5},
      number = {3},
      pages = {170-174},
      doi = {10.11648/j.ajp.20190503.25},
      url = {https://doi.org/10.11648/j.ajp.20190503.25},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20190503.25},
      abstract = {The aim of this study is 1) to determine the sensitivity and specificity of continuous heart rate characteristics (HRC) monitoring in detection of infections and 2) to evaluate whether HRC monitoring detects infections prior to onset of clinical symptoms in very low birth weight (VLBW) infants. A retrospective cohort study was conducted analyzing HRC scores and episodes of infection for VLBW infants in the Neonatal Intensive Care Unit (NICU) at Cincinnati Children’s Hospital Medical Center from January 2015 through May 2016. HRC scores were acquired using the HRC monitor system and entered into the electronic medical record by bedside staff. Culture-positive and culture-negative clinical infections were recorded. Positive HRC scores were defined as an increase 1 point above the baseline or the first rise above 2. HRC scores within 24 hours and also within the 5-day period before the start of antibiotics for infections were analyzed for sensitivity, specificity, positive predictive value and negative predictive value for detection of neonatal infection. The HRC score increase 1 point above the baseline or the first rise above 2 in the 24 hours before the start of antibiotics for infectious events had a sensitivity of 68.0%, a specificity of 10.8%. Positive predictive value (PPV) and negative predictive value (NPV) were 34.0% and 33.3%, respectively. The PPV and NPV were modestly higher for elevated HRC scores during the 5-day period before infections, 41.1% and 66.7%, respectively. In our single-center retrospective study, elevated HRC scores had limited ability to detect infection. More than half of the positive monitor events were not related to infection. The potential clinical impact of the monitor to detect infection before the onset of clinical symptoms was limited and the risk for unnecessary evaluation and treatment was high.},
     year = {2019}
    }
    

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  • TY  - JOUR
    T1  - Heart Rate Characteristic Index Monitoring for Early Detection of Infections in Very Low Birth Weight Infants
    AU  - Denise Moreira
    AU  - Kristin Melton
    AU  - Jareen Meinzen-Derr
    AU  - Meredith Tabangin
    AU  - Paul Kingma
    AU  - Kurt Schibler
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    DO  - 10.11648/j.ajp.20190503.25
    T2  - American Journal of Pediatrics
    JF  - American Journal of Pediatrics
    JO  - American Journal of Pediatrics
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    SN  - 2472-0909
    UR  - https://doi.org/10.11648/j.ajp.20190503.25
    AB  - The aim of this study is 1) to determine the sensitivity and specificity of continuous heart rate characteristics (HRC) monitoring in detection of infections and 2) to evaluate whether HRC monitoring detects infections prior to onset of clinical symptoms in very low birth weight (VLBW) infants. A retrospective cohort study was conducted analyzing HRC scores and episodes of infection for VLBW infants in the Neonatal Intensive Care Unit (NICU) at Cincinnati Children’s Hospital Medical Center from January 2015 through May 2016. HRC scores were acquired using the HRC monitor system and entered into the electronic medical record by bedside staff. Culture-positive and culture-negative clinical infections were recorded. Positive HRC scores were defined as an increase 1 point above the baseline or the first rise above 2. HRC scores within 24 hours and also within the 5-day period before the start of antibiotics for infections were analyzed for sensitivity, specificity, positive predictive value and negative predictive value for detection of neonatal infection. The HRC score increase 1 point above the baseline or the first rise above 2 in the 24 hours before the start of antibiotics for infectious events had a sensitivity of 68.0%, a specificity of 10.8%. Positive predictive value (PPV) and negative predictive value (NPV) were 34.0% and 33.3%, respectively. The PPV and NPV were modestly higher for elevated HRC scores during the 5-day period before infections, 41.1% and 66.7%, respectively. In our single-center retrospective study, elevated HRC scores had limited ability to detect infection. More than half of the positive monitor events were not related to infection. The potential clinical impact of the monitor to detect infection before the onset of clinical symptoms was limited and the risk for unnecessary evaluation and treatment was high.
    VL  - 5
    IS  - 3
    ER  - 

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Author Information
  • Maternal-Infant, Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil

  • Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA

  • Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA

  • Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA

  • Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA

  • Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA

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