title: Vital signs and their cross-correlation in sepsis and NEC: a study of 1,065 very-low-birth-weight infants in two NICUs.
abstract: Subtle changes in vital signs and their interactions occur in preterm infants prior to overt deterioration from late-onset septicemia (LOS) or necrotizing enterocolitis (NEC). Optimizing predictive algorithms may lead to earlier treatment.
  
  
  
  For 1,065 very-low-birth-weight (VLBW) infants in two neonatal intensive care units (NICUs), mean, SD, and cross-correlation of respiratory rate, heart rate (HR), and oxygen saturation (SpO2) were analyzed hourly (131 infant-years' data). Cross-correlation (cotrending) between two vital signs was measured allowing a lag of ± 30 s. Cases of LOS and NEC were identified retrospectively (n = 186) and vital sign models were evaluated for ability to predict illness diagnosed in the ensuing 24 h.
  
  
  
  The best single illness predictor within and between institutions was cross-correlation of HR-SpO2. The best combined model (mean SpO2, SDHR, and cross-correlation of HR-SpO2,) trained at one site with ROC area 0.695 had external ROC area of 0.754 at the other site, and provided additive value to an established HR characteristics index for illness prediction (Net Reclassification Improvement: 0.205; 95% confidence interval (CI): 0.113, 0.328).
  
  
  
  Despite minor inter-institutional differences in vital sign patterns of VLBW infants, cross-correlation of HR-SpO2and a 3-variable vital sign model performed well at both centers for preclinical detection of sepsis or NEC.
authors.affiliation: Department of Pediatrics, University of Virginia, Charlottesville, Virginia.
authors.forename: Karen D
authors.initials: KD
authors.lastname: Fairchild
authors.affiliation: Department of Medicine, University of Virginia, Charlottesville, Virginia.
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Lake
authors.affiliation: Department of Pediatrics, University of Virginia, Charlottesville, Virginia.
authors.forename: John
authors.initials: J
authors.lastname: Kattwinkel
authors.affiliation: Department of Medicine, University of Virginia, Charlottesville, Virginia.
authors.forename: J Randall
authors.initials: JR
authors.lastname: Moorman
authors.affiliation: Department of Pediatrics, Columbia University, New York, New York.
authors.forename: David A
authors.initials: DA
authors.lastname: Bateman
authors.affiliation: Department of Pediatrics, Columbia University, New York, New York.
authors.forename: Philip G
authors.initials: PG
authors.lastname: Grieve
authors.affiliation: Department of Pediatrics, Columbia University, New York, New York.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Isler
authors.affiliation: Department of Pediatrics, Columbia University, New York, New York.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Sahni
mesh_terms: D000465:Algorithms; D001724:Birth Weight; D057286:Electronic Health Records; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006339:Heart Rate; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal; D008297:Male; D010100:Oxygen / Q000378:metabolism; D012372:ROC Curve; D056152:Respiratory Rate; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D013997:Time Factors; D055986:Vital Signs
chemical_list: D010100:Oxygen