title: Predictive monitoring for sepsis and necrotizing enterocolitis to prevent shock.
abstract: Despite vigilant clinical assessment of infants in the neonatal intensive care unit (NICU), diagnosis of sepsis and necrotizing enterocolitis often does not occur until an infant has significant hemodynamic compromise. Predictive monitoring involves analysis of vital signs and other clinical data to identify infants at highest risk and to detect early-stage illness, leading to timelier treatment and improved outcomes. The first vital-sign predictive monitoring device developed for sepsis detection in babies in the NICU is the heart rate characteristics index (HeRO) monitor, which continuously analyzes the electrocardiogram signal for low heart rate variability and transient decelerations. Use of this monitor in very low birth weight infants (<1500 g) was shown in a large multicenter randomized clinical trial to significantly reduce mortality. The purpose of this review is (1) to summarize the physiologic changes in neonatal sepsis and progression to shock, (2) to review efforts toward risk stratification for sepsis shortly after birth based on demographic and physiologic scoring systems, (3) to describe development and implementation of heart rate characteristics monitoring and other important aspects of sepsis early warning systems, and (4) to provide an overview of current research analyzing multiple vital signs and other clinical variables in an attempt to develop even more effective predictive monitoring devices and systems.
authors.affiliation: Neonatal/Perinatal Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA. Electronic address: BSA4M@hscmail.mcc.virginia.edu.
authors.forename: Brynne A
authors.initials: BA
authors.lastname: Sullivan
authors.affiliation: Division of Neonatology, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: Karen D
authors.initials: KD
authors.lastname: Fairchild
mesh_terms: D020345:Enterocolitis, Necrotizing / Q000150:complications / Q000175:diagnosis*; D006339:Heart Rate; D006801:Humans; D007231:Infant, Newborn; D008991:Monitoring, Physiologic; D011237:Predictive Value of Tests; D018570:Risk Assessment; D018805:Sepsis / Q000150:complications / Q000175:diagnosis*; D012772:Shock, Septic / Q000209:etiology / Q000517:prevention & control*; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000517:prevention & control; D055986:Vital Signs / Q000502:physiology
keywords: Heart rate characteristic monitoring; Heart rate characteristics index; Necrotizing enterocolitis; Predictive monitoring; Sepsis; Shock; Systemic inflammatory response syndrome
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