Heart rate variability analysis is more sensitive at identifying neonatal sepsis than conventional vital signs

Bohanon, Fredrick J.; Mrazek, Amy A.; Shabana, M.T.; Mims, Sarah; Radhakrishnan, Geetha L.; Kramer, George C.; Radhakrishnan, Ravi S.

doi:10.1016/j.amjsurg.2015.06.002

Cited by 59 publications

(50 citation statements)

References 39 publications

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“…Probably the most advanced clinical applications of HRV can be found in neonatal intensive care medicine, in which HRV analysis has already been shown to add independent information to clinical signs scores and to allow for earlier diagnosis of neonatal sepsis. 7,26 Randomized clinical trials have revealed that heart rate characteristics monitoring can reduce the mortality rate in very low-birth weight infants 27 and is associated with a lower septicemia-associated mortality. 28 The main novel finding of this study is that the HRV is affected by even a moderate porcine sepsis without organ failure.…”

Section: Discussionmentioning

confidence: 99%

“…Depression of heart-rate variability (HRV) in conditions of systemic inflammation has been repeatedly shown in both patients [6][7][8][9][10] and experimental animal models. [11][12][13] In some studies, a predictive power of HRV was documented, in which depression of HRVderived parameters preceded the onset of overt clinical sepsis by several hours.…”

Section: Introductionmentioning

confidence: 99%

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Heart-rate variability depression in porcine peritonitis-induced sepsis without organ failure

Jarkovská

Valešová

Chvojka

et al. 2017

Exp Biol Med (Maywood)

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Depression of heart-rate variability (HRV) in conditions of systemic inflammation has been shown in both patients and experimental animal models and HRV has been suggested as an early indicator of sepsis. The sensitivity of HRV-derived parameters to the severity of sepsis, however, remains unclear. In this study we modified the clinically relevant porcine model of peritonitis-induced sepsis in order to avoid the development of organ failure and to test the sensitivity of HRV to such non-severe conditions. In 11 anesthetized, mechanically ventilated and instrumented domestic pigs of both sexes, sepsis was induced by fecal peritonitis. The dose of feces was adjusted and antibiotic therapy was administered to avoid multiorgan failure. Experimental subjects were screened for 40 h from the induction of sepsis. In all septic animals, sepsis with hyperdynamic circulation and increased plasma levels of inflammatory mediators developed within 12 h from the induction of peritonitis. The sepsis did not progress to multiorgan failure and there was no spontaneous death during the experiment despite a modest requirement for vasopressor therapy in most animals (9/11). A pronounced reduction of HRV and elevation of heart rate developed quickly (within 5 h, time constant of 1.97 ± 0.80 h for HRV parameter TINN) upon the induction of sepsis and were maintained throughout the experiment. The frequency domain analysis revealed a decrease in the high-frequency component. The reduction of HRV parameters and elevation of heart rate preceded sepsis-associated hemodynamic changes by several hours (time constant of 11.28 ± 2.07 h for systemic vascular resistance decline). A pronounced and fast reduction of HRV occurred in the setting of a moderate experimental porcine sepsis without organ failure. Inhibition of parasympathetic cardiac signaling probably represents the main mechanism of HRV reduction in sepsis. The sensitivity of HRV to systemic inflammation may allow early detection of a moderate sepsis without organ failure. Impact statement A pronounced and fast reduction of heart-rate variability occurred in the setting of a moderate experimental porcine sepsis without organ failure. Dominant reduction of heart-rate variability was found in the high-frequency band indicating inhibition of parasympathetic cardiac signaling as the main mechanism of heart-rate variability reduction. The sensitivity of heart-rate variability to systemic inflammation may contribute to an early detection of moderate sepsis without organ failure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Heart-rate variability depression in porcine peritonitis-induced sepsis without organ failure

Jarkovská

Valešová

Chvojka

et al. 2017

Exp Biol Med (Maywood)

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“…Meta-analysis was impossible due to heterogeneity between studies with respect to the assessment of both HIE and HRV. Many of the comparisons presented in this review were not controlled for important variables such as gestational age, birth weight, and different pathological conditions e.g., malformations and sepsis [54][55][56][57]. It is well known that these factors may depress HRV measures and thereby influence the results [54][55][56][57].…”

Section: Limitationsmentioning

confidence: 99%

Severity of hypoxic ischemic encephalopathy and heart rate variability in neonates: a systematic review

et al. 2019

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Background Several studies have investigated heart rate variability (HRV) as a biomarker for acute brain injury in hypoxic ischemic encephalopathy (HIE). However, the current evidence is heterogeneous and needs further reviewing to direct future studies. We aimed to systematically review whether HIE severity is associated with HRV. Methods This systematic review was conducted according to the preferred reporting items for systematic review and meta analyses (PRISMA). We included studies comparing neonates with severe or moderate HIE with neonates with mild or no HIE with respect to different HRV measures within 7 days of birth. Article selection and quality assessment was independently performed by two reviewers. Risk of bias and strength of evidence was evaluated by the Newcastle-Ottawa scale (NOS) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results We screened 1187 studies. From these, four observational studies with 248 neonates were included. For all HRV measures, the strength of evidence was very low. Neonates with severe or moderate HIE showed a reduction in most HRV measures compared to neonates with mild or no HIE with a greater reduction in those with severe HIE. Conclusions Moderate and severe HIE was associated with a reduction in most HRV measures. Accordingly, HRV is a potential biomarker for HIE severity during the first week of life. However, the uncertainty calls for more studies. Electronic supplementary material The online version of this article (10.1186/s12887-019-1603-7) contains supplementary material, which is available to authorized users.

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“…HRV features together with quantification of general physical movements have also been found useful for 2-year outcome prediction in [7]. In [8], time-domain HRV measurements have showed a significant difference between septic and nonseptic newborns. Decreased HRV was observed in children born with low birth weight, including preterm babies [9].…”

Section: Introductionmentioning

confidence: 99%

Heart Rate Variability during Periods of Low Blood Pressure as a Predictor of Short-Term Outcome in Preterms

Semenova

Carra

Lightbody

et al. 2018

2018 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC)

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Efficient management of low blood pressure (BP) in preterm neonates remains challenging with a considerable variability in clinical practice. The ability to assess preterm wellbeing during episodes of low BP will help to decide when and whether hypotension treatment should be initiated. This work aims to investigate the relationship between heart rate variability (HRV), BP and the short-term neurological outcome in preterm infants less than 32 weeks gestational age (GA). The predictive power of common HRV features with respect to the outcome is assessed and shown to improve when HRV is observed during episodes of low mean arterial pressure (MAP)with a single best feature leading to an AUC of 0.87. Combining multiple features with a boosted decision tree classifier achieves an AUC of 0.97. The work presents a promising step towards the use of multimodal data in building an objective decision support tool for clinical prediction of short-term outcome in preterms who suffer episodes of low BP.

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Heart rate variability analysis is more sensitive at identifying neonatal sepsis than conventional vital signs

Cited by 59 publications

References 39 publications

Heart-rate variability depression in porcine peritonitis-induced sepsis without organ failure

Heart-rate variability depression in porcine peritonitis-induced sepsis without organ failure

Severity of hypoxic ischemic encephalopathy and heart rate variability in neonates: a systematic review

Heart Rate Variability during Periods of Low Blood Pressure as a Predictor of Short-Term Outcome in Preterms

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