Heart rate characteristics: physiomarkers for detection of late-onset neonatal sepsis.
Early detection of late-onset neonatal sepsis, before the onset of obvious and potentially catastrophic clinical signs, is an important goal in neonatal medicine. Sepsis causes a well-known series of physiologic changes including abnormalities of blood pressure, respiration, temperature, and heart rate, and less well-known changes in heart rate variability. Although vital signs are frequently or continuously monitored in patients in the neonatal intensive care unit (NICU), changes in these parameters are subtle in the early phase of sepsis and difficult to interpret using traditional NICU monitoring tools. A new tool, continuous monitoring of heart rate characteristics (HRC), is now available for clinical use. Recent research has established that 2 abnormalities of HRC that have long been used by obstetricians to identify fetal compromise, reduced heart rate variability and transient decelerations, occur early in the course of sepsis in patients in the NICU, often before clinical signs of illness. Through mathematical modeling of electrocardiogram data from hundreds of patients in the NICU, an HRC index that represents the fold increase in risk that a neonate will be diagnosed with clinical or culture-proven sepsis within the next 24 hours was derived. The effect of continuous HRC monitoring on outcomes in preterm very low birth weight infants is the subject of a multicenter randomized clinical trial of 3000 patients, which will be complete in 2010. Further research into mechanisms of abnormal HRC and regulation of autonomic nervous system function in sepsis and other disease processes will shed light on additional applications of this exciting new technology.
Fairchild
Karen D
KD
Division of Neonatology, University of Virginia, Hospital Drive, Charlottesville, VA 22908, USA. kdf2n@virginia.edu
O'Shea
T Michael
TM
D006339:Heart Rate; D006801:Humans; D007231:Infant, Newborn; D008991:Monitoring, Physiologic / Q000379:methods*; D018805:Sepsis / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D015996:Survival Rate
Pediatrics. 2009 Jan;123(1):313-8
19117897
J Perinatol. 2009 Nov;29(11):750-6
19554011
J Exp Med. 2002 Mar 18;195(6):781-8
11901203
J Immunol. 2009 Nov 15;183(10):6681-8
19846875
Am J Respir Crit Care Med. 1999 Aug;160(2):458-65
10430714
Ann N Y Acad Sci. 2006 Nov;1088:361-72
17192580
Am J Physiol. 1998 Oct;275(4):R1287-92
9756562
Obstet Gynecol. 2005 Mar;105(3):458-65
15738008
Physiol Rev. 2008 Jul;88(3):919-82
18626064
J Intensive Care Med. 2009 Sep-Oct;24(5):293-316
19703817
Am J Physiol. 1991 Oct;261(4 Pt 2):H1231-45
1928405
Am J Respir Cell Mol Biol. 2007 Aug;37(2):186-92
17431097
Pediatrics. 2005 Apr;115(4):937-41
15805367
Br J Obstet Gynaecol. 1998 Jul;105(7):749-55
9692416
Pediatr Res. 2007 Feb;61(2):222-7
17237726
Pediatrics. 1980 Jan;65(1):50-6
7355036
Ann Biomed Eng. 2004 Feb;32(2):233-44
15008371
J Cardiovasc Electrophysiol. 1994 Feb;5(2):112-24
8186882
Am J Physiol Regul Integr Comp Physiol. 2009 Oct;297(4):R1019-27
19657103
J Crit Care. 2009 Dec;24(4):625.e1-7
19327330
J Immunol. 2010 Jan 1;184(1):401-10
19949071
Am J Obstet Gynecol. 1983 Oct 15;147(4):391-5
6624808
Crit Care Med. 1996 Aug;24(8):1373-80
8706494
Pediatrics. 1965 Oct;36(4):551-9
5834061
Pediatr Res. 2003 Jun;53(6):920-6
12646726
Shock. 2001 Oct;16(4):274-7
11580109
Mol Med. 2007 Mar-Apr;13(3-4):178-84
17592552
Circulation. 1996 Mar 1;93(5):1043-65
8598068
J Endotoxin Res. 2007;13(6):358-68
18182463
Auton Neurosci. 2000 Dec 20;85(1-3):49-59
11189026
Psychoneuroendocrinology. 2008 Nov;33(10):1305-12
18819754
Circ Shock. 1990 Jan;30(1):51-61
2154342
Pediatrics. 2005 Nov;116(5):1070-4
16263991
Ann Biomed Eng. 2001 Sep;29(9):764-74
11599584
Pediatrics. 2002 Aug;110(2 Pt 1):285-91
12165580
Mol Cell Biochem. 1996 Oct-Nov;163-164:291-303
8974069
Pediatr Res. 2003 Dec;54(6):892-8
12930915
Psychother Psychosom. 1999 Mar-Apr;68(2):59-66
10026456
Am J Public Health. 1999 Apr;89(4):511-6
10191793
J Soc Gynecol Investig. 1998 Jul-Aug;5(4):188-91
9699176
J Clin Invest. 2007 Feb;117(2):289-96
17273548
Pediatr Res. 2004 May;55(5):782-8
14739356
Curr Opin Crit Care. 2002 Oct;8(5):371-5
12357103
IEEE Trans Biomed Eng. 2006 Jan;53(1):111-8
16402610
IEEE Trans Biomed Eng. 2006 Jan;53(1):126-32
16402612
Clin Nephrol. 2005 Dec;64(6):419-27
16370154
Shock. 2007 Nov;28(5):549-53
18075483
Am J Physiol Regul Integr Comp Physiol. 2002 Sep;283(3):R789-97
12185014
Med Biol Eng Comput. 2006 Dec;44(12):1031-51
17111118
Pediatrics. 2001 Jan;107(1):97-104
11134441
CNS Drugs. 2009;23(7):583-602
19552486
J Am Coll Surg. 2007 May;204(5):885-92; discussion 892-3
17481504
Crit Care Med. 2008 May;36(5):1481-6
18434902
Mol Med. 2008 Sep-Oct;14(9-10):567-74
18584048
Am J Emerg Med. 2008 May;26(4):395-401
18410805
Shock. 2010 Apr;33(4):363-8
20407404
Nature. 2000 May 25;405(6785):458-62
10839541
Biol Neonate. 2000 Mar;77(3):147-55
10729717
Crit Care Med. 2000 Dec;28(12):3939-40
11153643
Crit Care Med. 2000 Dec;28(12):3907-12
11153634