Heart Rate Characteristic Index Monitoring for Early Detection of Infections in Very Low Birth Weight Infants

Denise Moreira; Kristin Melton; Jareen Meinzen-Derr; Meredith Tabangin; Paul Kingma; Kurt Schibler

doi:doi:10.11648/j.ajp.20190503.25

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Heart Rate Characteristic Index Monitoring for Early Detection of Infections in Very Low Birth Weight Infants

Denise Moreira, Kristin Melton, Jareen Meinzen-Derr, Meredith Tabangin, Paul Kingma, Kurt Schibler

Published in American Journal of Pediatrics (Volume 5, Issue 3)

Received: 16 July 2019 Accepted: 13 August 2019 Published: 28 August 2019

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Abstract

The aim of this study is 1) to determine the sensitivity and specificity of continuous heart rate characteristics (HRC) monitoring in detection of infections and 2) to evaluate whether HRC monitoring detects infections prior to onset of clinical symptoms in very low birth weight (VLBW) infants. A retrospective cohort study was conducted analyzing HRC scores and episodes of infection for VLBW infants in the Neonatal Intensive Care Unit (NICU) at Cincinnati Children’s Hospital Medical Center from January 2015 through May 2016. HRC scores were acquired using the HRC monitor system and entered into the electronic medical record by bedside staff. Culture-positive and culture-negative clinical infections were recorded. Positive HRC scores were defined as an increase 1 point above the baseline or the first rise above 2. HRC scores within 24 hours and also within the 5-day period before the start of antibiotics for infections were analyzed for sensitivity, specificity, positive predictive value and negative predictive value for detection of neonatal infection. The HRC score increase 1 point above the baseline or the first rise above 2 in the 24 hours before the start of antibiotics for infectious events had a sensitivity of 68.0%, a specificity of 10.8%. Positive predictive value (PPV) and negative predictive value (NPV) were 34.0% and 33.3%, respectively. The PPV and NPV were modestly higher for elevated HRC scores during the 5-day period before infections, 41.1% and 66.7%, respectively. In our single-center retrospective study, elevated HRC scores had limited ability to detect infection. More than half of the positive monitor events were not related to infection. The potential clinical impact of the monitor to detect infection before the onset of clinical symptoms was limited and the risk for unnecessary evaluation and treatment was high.

Published in	American Journal of Pediatrics (Volume 5, Issue 3)
DOI	10.11648/j.ajp.20190503.25
Page(s)	170-174
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

HeRO Monitor, Neonatal Infection, Sepsis

References

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APA Style

Denise Moreira, Kristin Melton, Jareen Meinzen-Derr, Meredith Tabangin, Paul Kingma, et al. (2019). Heart Rate Characteristic Index Monitoring for Early Detection of Infections in Very Low Birth Weight Infants. American Journal of Pediatrics, 5(3), 170-174. https://doi.org/10.11648/j.ajp.20190503.25

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ACS Style

Denise Moreira; Kristin Melton; Jareen Meinzen-Derr; Meredith Tabangin; Paul Kingma, et al. Heart Rate Characteristic Index Monitoring for Early Detection of Infections in Very Low Birth Weight Infants. Am. J. Pediatr. 2019, 5(3), 170-174. doi: 10.11648/j.ajp.20190503.25

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AMA Style

Denise Moreira, Kristin Melton, Jareen Meinzen-Derr, Meredith Tabangin, Paul Kingma, et al. Heart Rate Characteristic Index Monitoring for Early Detection of Infections in Very Low Birth Weight Infants. Am J Pediatr. 2019;5(3):170-174. doi: 10.11648/j.ajp.20190503.25

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@article{10.11648/j.ajp.20190503.25,
  author = {Denise Moreira and Kristin Melton and Jareen Meinzen-Derr and Meredith Tabangin and Paul Kingma and Kurt Schibler},
  title = {Heart Rate Characteristic Index Monitoring for Early Detection of Infections in Very Low Birth Weight Infants},
  journal = {American Journal of Pediatrics},
  volume = {5},
  number = {3},
  pages = {170-174},
  doi = {10.11648/j.ajp.20190503.25},
  url = {https://doi.org/10.11648/j.ajp.20190503.25},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20190503.25},
  abstract = {The aim of this study is 1) to determine the sensitivity and specificity of continuous heart rate characteristics (HRC) monitoring in detection of infections and 2) to evaluate whether HRC monitoring detects infections prior to onset of clinical symptoms in very low birth weight (VLBW) infants. A retrospective cohort study was conducted analyzing HRC scores and episodes of infection for VLBW infants in the Neonatal Intensive Care Unit (NICU) at Cincinnati Children’s Hospital Medical Center from January 2015 through May 2016. HRC scores were acquired using the HRC monitor system and entered into the electronic medical record by bedside staff. Culture-positive and culture-negative clinical infections were recorded. Positive HRC scores were defined as an increase 1 point above the baseline or the first rise above 2. HRC scores within 24 hours and also within the 5-day period before the start of antibiotics for infections were analyzed for sensitivity, specificity, positive predictive value and negative predictive value for detection of neonatal infection. The HRC score increase 1 point above the baseline or the first rise above 2 in the 24 hours before the start of antibiotics for infectious events had a sensitivity of 68.0%, a specificity of 10.8%. Positive predictive value (PPV) and negative predictive value (NPV) were 34.0% and 33.3%, respectively. The PPV and NPV were modestly higher for elevated HRC scores during the 5-day period before infections, 41.1% and 66.7%, respectively. In our single-center retrospective study, elevated HRC scores had limited ability to detect infection. More than half of the positive monitor events were not related to infection. The potential clinical impact of the monitor to detect infection before the onset of clinical symptoms was limited and the risk for unnecessary evaluation and treatment was high.},
 year = {2019}
}

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TY  - JOUR
T1  - Heart Rate Characteristic Index Monitoring for Early Detection of Infections in Very Low Birth Weight Infants
AU  - Denise Moreira
AU  - Kristin Melton
AU  - Jareen Meinzen-Derr
AU  - Meredith Tabangin
AU  - Paul Kingma
AU  - Kurt Schibler
Y1  - 2019/08/28
PY  - 2019
N1  - https://doi.org/10.11648/j.ajp.20190503.25
DO  - 10.11648/j.ajp.20190503.25
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 170
EP  - 174
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20190503.25
AB  - The aim of this study is 1) to determine the sensitivity and specificity of continuous heart rate characteristics (HRC) monitoring in detection of infections and 2) to evaluate whether HRC monitoring detects infections prior to onset of clinical symptoms in very low birth weight (VLBW) infants. A retrospective cohort study was conducted analyzing HRC scores and episodes of infection for VLBW infants in the Neonatal Intensive Care Unit (NICU) at Cincinnati Children’s Hospital Medical Center from January 2015 through May 2016. HRC scores were acquired using the HRC monitor system and entered into the electronic medical record by bedside staff. Culture-positive and culture-negative clinical infections were recorded. Positive HRC scores were defined as an increase 1 point above the baseline or the first rise above 2. HRC scores within 24 hours and also within the 5-day period before the start of antibiotics for infections were analyzed for sensitivity, specificity, positive predictive value and negative predictive value for detection of neonatal infection. The HRC score increase 1 point above the baseline or the first rise above 2 in the 24 hours before the start of antibiotics for infectious events had a sensitivity of 68.0%, a specificity of 10.8%. Positive predictive value (PPV) and negative predictive value (NPV) were 34.0% and 33.3%, respectively. The PPV and NPV were modestly higher for elevated HRC scores during the 5-day period before infections, 41.1% and 66.7%, respectively. In our single-center retrospective study, elevated HRC scores had limited ability to detect infection. More than half of the positive monitor events were not related to infection. The potential clinical impact of the monitor to detect infection before the onset of clinical symptoms was limited and the risk for unnecessary evaluation and treatment was high.
VL  - 5
IS  - 3
ER  -

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Author Information

Denise Moreira

Maternal-Infant, Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
Kristin Melton

Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
Jareen Meinzen-Derr

Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
Meredith Tabangin

Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
Paul Kingma

Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
Kurt Schibler

Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA

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APA Style

Denise Moreira, Kristin Melton, Jareen Meinzen-Derr, Meredith Tabangin, Paul Kingma, et al. (2019). Heart Rate Characteristic Index Monitoring for Early Detection of Infections in Very Low Birth Weight Infants. American Journal of Pediatrics, 5(3), 170-174. https://doi.org/10.11648/j.ajp.20190503.25

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ACS Style

Denise Moreira; Kristin Melton; Jareen Meinzen-Derr; Meredith Tabangin; Paul Kingma, et al. Heart Rate Characteristic Index Monitoring for Early Detection of Infections in Very Low Birth Weight Infants. Am. J. Pediatr. 2019, 5(3), 170-174. doi: 10.11648/j.ajp.20190503.25

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AMA Style

Denise Moreira, Kristin Melton, Jareen Meinzen-Derr, Meredith Tabangin, Paul Kingma, et al. Heart Rate Characteristic Index Monitoring for Early Detection of Infections in Very Low Birth Weight Infants. Am J Pediatr. 2019;5(3):170-174. doi: 10.11648/j.ajp.20190503.25

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@article{10.11648/j.ajp.20190503.25,
  author = {Denise Moreira and Kristin Melton and Jareen Meinzen-Derr and Meredith Tabangin and Paul Kingma and Kurt Schibler},
  title = {Heart Rate Characteristic Index Monitoring for Early Detection of Infections in Very Low Birth Weight Infants},
  journal = {American Journal of Pediatrics},
  volume = {5},
  number = {3},
  pages = {170-174},
  doi = {10.11648/j.ajp.20190503.25},
  url = {https://doi.org/10.11648/j.ajp.20190503.25},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20190503.25},
  abstract = {The aim of this study is 1) to determine the sensitivity and specificity of continuous heart rate characteristics (HRC) monitoring in detection of infections and 2) to evaluate whether HRC monitoring detects infections prior to onset of clinical symptoms in very low birth weight (VLBW) infants. A retrospective cohort study was conducted analyzing HRC scores and episodes of infection for VLBW infants in the Neonatal Intensive Care Unit (NICU) at Cincinnati Children’s Hospital Medical Center from January 2015 through May 2016. HRC scores were acquired using the HRC monitor system and entered into the electronic medical record by bedside staff. Culture-positive and culture-negative clinical infections were recorded. Positive HRC scores were defined as an increase 1 point above the baseline or the first rise above 2. HRC scores within 24 hours and also within the 5-day period before the start of antibiotics for infections were analyzed for sensitivity, specificity, positive predictive value and negative predictive value for detection of neonatal infection. The HRC score increase 1 point above the baseline or the first rise above 2 in the 24 hours before the start of antibiotics for infectious events had a sensitivity of 68.0%, a specificity of 10.8%. Positive predictive value (PPV) and negative predictive value (NPV) were 34.0% and 33.3%, respectively. The PPV and NPV were modestly higher for elevated HRC scores during the 5-day period before infections, 41.1% and 66.7%, respectively. In our single-center retrospective study, elevated HRC scores had limited ability to detect infection. More than half of the positive monitor events were not related to infection. The potential clinical impact of the monitor to detect infection before the onset of clinical symptoms was limited and the risk for unnecessary evaluation and treatment was high.},
 year = {2019}
}

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TY  - JOUR
T1  - Heart Rate Characteristic Index Monitoring for Early Detection of Infections in Very Low Birth Weight Infants
AU  - Denise Moreira
AU  - Kristin Melton
AU  - Jareen Meinzen-Derr
AU  - Meredith Tabangin
AU  - Paul Kingma
AU  - Kurt Schibler
Y1  - 2019/08/28
PY  - 2019
N1  - https://doi.org/10.11648/j.ajp.20190503.25
DO  - 10.11648/j.ajp.20190503.25
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 170
EP  - 174
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20190503.25
AB  - The aim of this study is 1) to determine the sensitivity and specificity of continuous heart rate characteristics (HRC) monitoring in detection of infections and 2) to evaluate whether HRC monitoring detects infections prior to onset of clinical symptoms in very low birth weight (VLBW) infants. A retrospective cohort study was conducted analyzing HRC scores and episodes of infection for VLBW infants in the Neonatal Intensive Care Unit (NICU) at Cincinnati Children’s Hospital Medical Center from January 2015 through May 2016. HRC scores were acquired using the HRC monitor system and entered into the electronic medical record by bedside staff. Culture-positive and culture-negative clinical infections were recorded. Positive HRC scores were defined as an increase 1 point above the baseline or the first rise above 2. HRC scores within 24 hours and also within the 5-day period before the start of antibiotics for infections were analyzed for sensitivity, specificity, positive predictive value and negative predictive value for detection of neonatal infection. The HRC score increase 1 point above the baseline or the first rise above 2 in the 24 hours before the start of antibiotics for infectious events had a sensitivity of 68.0%, a specificity of 10.8%. Positive predictive value (PPV) and negative predictive value (NPV) were 34.0% and 33.3%, respectively. The PPV and NPV were modestly higher for elevated HRC scores during the 5-day period before infections, 41.1% and 66.7%, respectively. In our single-center retrospective study, elevated HRC scores had limited ability to detect infection. More than half of the positive monitor events were not related to infection. The potential clinical impact of the monitor to detect infection before the onset of clinical symptoms was limited and the risk for unnecessary evaluation and treatment was high.
VL  - 5
IS  - 3
ER  -

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