Early Heart Rate Characteristics Predict Death and Morbidities in Preterm Infants.
OBJECTIVE
To determine whether an early heart rate characteristics (HRC) index (HeRO score), measured in the first day and week after birth predicts death and morbidities compared with established illness severity scores.


METHODS
For all very low birth weight infants in a single neonatal intensive care unit from 2004-2014, the average first day HRC index was calculated within 24 hours of birth (aHRC-24h) and the average first week HRC index within 7 days of birth (aHRC-7d). The Score for Neonatal Acute Physiology (SNAP-II) and Clinical Risk Indicator for Babies (CRIB-II) were calculated when data were available. The aHRC was compared with the SNAP-II and CRIB-II for predicting death, late-onset septicemia, necrotizing enterocolitis, bronchopulmonary dysplasia, severe intraventricular hemorrhage, or severe retinopathy of prematurity.


RESULTS
All 4 scores were associated with death and severe intraventricular hemorrhage (P < .01). The OR and 95% CI for every 1-point increase in aHRC for predicting mortality, adjusted for gestational age, was 1.59 (1.25-2.00) for aHRC-24h and 2.61 (1.58-4.33) for aHRC-7d. High aHRC-7d, SNAP-II, and CRIB-II were associated with bronchopulmonary dysplasia (P < .001). High aHRC-7d was associated with late-onset septicemia (P < .05). None of the scores predicted necrotizing enterocolitis or severe retinopathy of prematurity.


CONCLUSIONS
HRC assessed in the first day or first week after birth compares favorably to established risk scores to predict death and morbidities in very low birth weight infants.
Department of Pediatrics, University of Virginia, Charlottesville, VA. Electronic address: bsa4m@virginia.edu.
Brynne A
BA
Sullivan
Department of Pediatrics, University of Virginia, Charlottesville, VA.
Christina
C
McClure
Department of Pediatrics, University of Virginia, Charlottesville, VA.
Jamie
J
Hicks
Department of Medicine, University of Virginia, Charlottesville, VA.
Douglas E
DE
Lake
Department of Medicine, University of Virginia, Charlottesville, VA.
J Randall
JR
Moorman
Department of Pediatrics, University of Virginia, Charlottesville, VA.
Karen D
KD
Fairchild
D000367:Age Factors; D015331:Cohort Studies; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology; D019102:Infant, Very Low Birth Weight; D008297:Male; D011237:Predictive Value of Tests; D012372:ROC Curve; D012720:Severity of Illness Index
CRIB; SNAP; bronchopulmonary dysplasia; heart rate characteristics; illness severity score; intraventricular hemorrhage; septicemia; very low birth weight infants