title: Heart rate variability analysis is more sensitive at identifying neonatal sepsis than conventional vital signs.
abstract: BACKGROUND
  Sepsis remains the largest preventable source of neonatal mortality in the world. Heart rate variability (HRV) analysis and noninvasive cardiac output have been shown to be useful adjuncts to sepsis detection in many patient groups.
  
  
  METHODS
  With Institutional Review Board approval, 4 septic and 6 nonseptic extremely low birth weight patients were enrolled. Data from septic and healthy patients were collected for 5 hours. Electrocardiogram waveform and traditional vital signs were collected and the RR intervals were calculated; then HRV analysis was performed in both the time and frequency domain.
  
  
  RESULTS
  HRV measurements in time domain, heart rate, and pulse oximetry (SpO2) were significantly different in septic patients vs nonseptic controls.
  
  
  CONCLUSIONS
  These results indicate that nonconventional vital signs such as HRV are more sensitive than traditionally used vital signs, such as cardiac output and mean arterial pressure, in the confirmation of sepsis in extremely low birth weight neonates. HRV may allow for earlier identification of septic physiology.
authors.affiliation: Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA.
authors.forename: Fredrick J
authors.initials: FJ
authors.lastname: Bohanon
authors.affiliation: Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA.
authors.forename: Amy A
authors.initials: AA
authors.lastname: Mrazek
authors.affiliation: Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA.
authors.forename: Mohamed T
authors.initials: MT
authors.lastname: Shabana
authors.affiliation: Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mims
authors.affiliation: Department of Pediatrics, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA.
authors.forename: Geetha L
authors.initials: GL
authors.lastname: Radhakrishnan
authors.affiliation: Department of Anesthesiology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA.
authors.forename: George C
authors.initials: GC
authors.lastname: Kramer
authors.affiliation: Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA; Department of Pediatrics, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA. Electronic address: rsradhak@utmb.edu.
authors.forename: Ravi S
authors.initials: RS
authors.lastname: Radhakrishnan
mesh_terms: D016022:Case-Control Studies; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis* / Q000503:physiopathology*; D008297:Male; D010092:Oximetry; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis* / Q000503:physiopathology*
keywords: Heart rate variability; Neonatal; Noninvasive vital signs; Sepsis