Monitoring of heart rate characteristics to detect neonatal sepsis

Rio, Laura; Ramelet, Anne‐Sylvie; Ballabeni, Pierluigi; Stadelmann, Corinne; Asner, Sandra; Giannoni, Éric

doi:10.1038/s41390-021-01913-9

Cited by 5 publications

(7 citation statements)

References 24 publications

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“…The corollary of this is that chronic, slowly worsening levels of fetal inflammation seem to be unlikely to be detectable by even in-depth FHRV analysis, despite being associated with neuroinflammation and impaired neurodevelopment 24 . The limited effect on FHRV observed in the progressive LPS group may in part help explain the recent finding that a sizeable portion of neonates with culture-proven late-onset sepsis were not identified by HRV analysis via the heart rate characteristic system 18 .…”

Section: Discussionmentioning

confidence: 94%

“…The key heart rate features of neonatal infection include asymmetrical heart rate traces, reduced time domain measures of HRV, with reduced sample entropy and measures of nonlinear HRV 13 , 15 , 17 . The combined analysis of these measures into a single score called the heart rate characteristic index has recently been reported to have an overall sensitivity of 53% and specificity of 80% for culture-proven late-onset neonatal sepsis across all gestational ages 18 . Moreover, a higher sensitivity of 76% but specificity of 63% was found among infants born < 28 weeks 18 , supporting a moderate ability to identify sepsis among extremely preterm infants.…”

Section: Introductionmentioning

confidence: 99%

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Fetal heart rate variability is a biomarker of rapid but not progressive exacerbation of inflammation in preterm fetal sheep

Magawa

Lear

Beacom

et al. 2022

Sci Rep

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Perinatal infection/inflammation can trigger preterm birth and contribute to neurodevelopmental disability. There are currently no sensitive, specific methods to identify perinatal infection. We investigated the utility of time, frequency and non-linear measures of fetal heart rate (FHR) variability (FHRV) to identify either progressive or more rapid inflammation. Chronically instrumented preterm fetal sheep were randomly assigned to one of three different 5d continuous i.v. infusions: 1) control (saline infusions; n = 10), 2) progressive lipopolysaccharide (LPS; 200 ng/kg over 24 h, doubled every 24 h for 5d, n = 8), or 3) acute-on-chronic LPS (100 ng/kg over 24 h then 250 ng/kg/24 h for 4d plus 1 μg boluses at 48, 72, and 96 h, n = 9). Both LPS protocols triggered transient increases in multiple measures of FHRV at the onset of infusions. No FHRV or physiological changes occurred from 12 h after starting progressive LPS infusions. LPS boluses during the acute-on-chronic protocol triggered transient hypotension, tachycardia and an initial increase in multiple time and frequency domain measures of FHRV, with an asymmetric FHR pattern of predominant decelerations. Following resolution of hypotension after the second and third LPS boluses, all frequencies of FHRV became suppressed. These data suggest that FHRV may be a useful biomarker of rapid but not progressive preterm infection/inflammation.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Fetal heart rate variability is a biomarker of rapid but not progressive exacerbation of inflammation in preterm fetal sheep

Magawa

Lear

Beacom

et al. 2022

Sci Rep

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“…Four other additional reports of this RCT were excluded from this review because these reports investigated subpopulations of preterm infants [5,20] or a different primary outcome of interest [21,22]. Of the twelve cohort studies [6,7,[23][24][25][26][27][28][29][30][31][32], four were identified as duplicated cohort studies [23][24][25][26][27].…”

Section: Study Selectionmentioning

confidence: 99%

“…These studies calculated the HRC index or sample asymmetry as a degree of reduced heart rate variability and transient decelerations [6,7,[23][24][25][26][27][28]. Except for one study using Nevrokard aHRV software (Nevrokard Kiauta; Slovenia) [30], the studies published after 2010 used the HeRO monitor [3,18,19,29,31,32]. The definition of LOS and the percentage of infants diagnosed with LOS were very heterogeneous between the studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Seven cohort studies reporting their results in twelve manuscripts and including a total of 5,227 participants were identified in this review [6,7,[23][24][25][26][27][28][29][30][31][32]. Data of subpopulations from one large cohort of preterm infants [26] were used in several publications comparing either HRC to laboratory results [27], clinical signs [6], for deriving and validating HRC as a prediction model for LOS and sepsis-like illness [23], different aspects of HRC [24], or other outcomes [25].…”

Section: Description Of the Cohort Studiesmentioning

confidence: 99%

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Heart Rate Characteristics Monitoring for Late-Onset Sepsis in Preterm Infants: A Systematic Review

Koppens,

Onland,

Visser

et al. 2023

Neonatology

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Background: Early diagnosis of late-onset sepsis (LOS) and necrotizing enterocolitis (NEC) by monitoring heart rate characteristics (HRC) of preterm infants might reduce the risk of death and morbidities. We aimed to systematically assess the effects of HRC monitoring on death, LOS, and NEC. Methods: A systematic search was performed in MEDLINE, Embase, Cochrane Library, and Web of Science. Results: Fifteen papers were included in this review. Three of these papers reported results from the only identified randomized controlled trial (RCT). This RCT showed that HRC monitoring resulted in a small but significant reduction in mortality (absolute risk reduction 2.1% [95% confidence interval 0.01–4.14]) without any differences in neurodevelopmental impairment. The risk of bias was rated high due to performance and detection bias and failure to correct for multiple testing. Most diagnostic cohort studies showed high discriminating accuracy in predicting LOS but lacked sufficient quality and generalizability. No studies for the detection of NEC were identified. Conclusion: Supported by multiple observational cohort studies, the RCT identified in this systematic review showed that HRC monitoring as an early warning system for LOS might reduce the risk of death in preterm infants. However, methodological weaknesses and limited generalizability do not justify implementation of HRC in clinical care. A large international RCT is warranted.

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Early detection of neonatal sepsis and reduction of overall antibiotic exposure: Towards precision medicine

Stocker,

Fillistorf,

Carra

et al. 2024

Archives de Pédiatrie

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Monitoring of heart rate characteristics to detect neonatal sepsis

Cited by 5 publications

References 24 publications

Fetal heart rate variability is a biomarker of rapid but not progressive exacerbation of inflammation in preterm fetal sheep

Fetal heart rate variability is a biomarker of rapid but not progressive exacerbation of inflammation in preterm fetal sheep

Heart Rate Characteristics Monitoring for Late-Onset Sepsis in Preterm Infants: A Systematic Review

Early detection of neonatal sepsis and reduction of overall antibiotic exposure: Towards precision medicine

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