Heart rate characteristics monitoring for neonatal sepsis

While heart rate variability has been measured in many clinical settings and has offered insights into how HR is controlled, rarely has it offered unique information that has led to changes in patient management. We review our experience in developing continuous HR characteristics monitoring to aid in the early diagnosis of sepsis in premature infants in the neonatal intensive care unit. A predictive algorithm, developed at one center and validated at another, has led to diagnosis and treatment of this subacute and potentially catastrophic illness prior to appearance of symptoms of severe illness.

[1]  Stephen W Porges,et al.  Vagal Responsiveness to Gavage Feeding as an Index of Preterm Status , 1991, Pediatric Research.

[2]  George B. Moody,et al.  Spectral analysis of heart rate without resampling , 1993, Proceedings of Computers in Cardiology Conference.

[3]  Samir Soneji,et al.  Serial assessment of mortality in the neonatal intensive care unit by algorithm and intuition: certainty, uncertainty, and informed consent. , 2002, Pediatrics.

[4]  F. Harrell,et al.  Abnormal Heart Rate Characteristics Are Associated with Neonatal Mortality , 2004, Pediatric Research.

[5]  M. P. Griffin,et al.  Toward the early diagnosis of neonatal sepsis and sepsis-like illness using novel heart rate analysis. , 2001, Pediatrics.

[6]  C R Bauer,et al.  Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. , 1996, The Journal of pediatrics.

[7]  M C McCormick,et al.  Coagulase-negative staphylococcal bacteremia among very low birth weight infants: relation to admission illness severity, resource use, and outcome. , 1995, Pediatrics.

[8]  J. E. Carceller.  American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis , 1992, Critical care medicine.

[9]  Solange Akselrod,et al.  Development and Maturation of the Autonomic Nervous System in Premature and Full-Term Infants Using Spectral Analysis of Heart Rate Fluctuations , 1995, Pediatric Research.

[10]  M. P. Griffin,et al.  Increased Nonstationarity of Neonatal Heart Rate Before the Clinical Diagnosis of Sepsis , 2004, Annals of Biomedical Engineering.

[11]  Brahm Goldstein,et al.  Linear and nonlinear analysis of hemodynamic signals during sepsis and septic shock , 2000, Critical care medicine.

[12]  S M Pincus,et al.  Greater signal regularity may indicate increased system isolation. , 1994, Mathematical biosciences.

[13]  M. P. Griffin,et al.  Heart Rate Characteristics and Laboratory Tests in Neonatal Sepsis , 2005, Pediatrics.

[14]  D. Eckberg.  Sympathovagal balance: a critical appraisal. , 1997, Circulation.

[15]  G. Billman,et al.  Low-frequency component of the heart rate variability spectrum: a poor marker of sympathetic activity. , 1999, American journal of physiology. Heart and circulatory physiology.

[16]  M. Pamela Griffin,et al.  Comparison and Clinical Application of Frequency Domain Methods in Analysis of Neonatal Heart Rate Time Series , 2001, Annals of Biomedical Engineering.

[17]  S M Pincus,et al.  Approximate entropy as a measure of system complexity. , 1991, Proceedings of the National Academy of Sciences of the United States of America.

[18]  L. Mccawley,et al.  Cytokine elevations in critically ill infants with sepsis and necrotizing enterocolitis. , 1994, The Journal of pediatrics.

[19]  R. Harper,et al.  The maturation of correlations between cardiac and respiratory measures across sleep states in normal infants. , 1992, Sleep.

[20]  M. P. Griffin,et al.  Sample Asymmetry Analysis of Heart Rate Characteristics with Application to Neonatal Sepsis and Systemic Inflammatory Response Syndrome , 2003, Pediatric Research.

[21]  J. Richman,et al.  Sample entropy. , 2004, Methods in enzymology.

[22]  J Yang,et al.  Progressive internalization of beta-adrenoceptors in the rat liver during different phases of sepsis. , 1998, Biochimica et biophysica acta.

[23]  M. Finkel,et al.  Cytokines and nitric oxide synthase inhibitor as mediators of adrenergic refractoriness in cardiac myocytes. , 1997, European journal of pharmacology.

[24]  Jonathan Cohen,et al.  Pathogenesis and potential strategies for prevention and treatment of septic shock: an update. , 1994, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[25]  A L Goldberger,et al.  Physiological time-series analysis: what does regularity quantify? , 1994, The American journal of physiology.

[26]  F. Harrell,et al.  Abnormal Heart Rate Characteristics Preceding Neonatal Sepsis and Sepsis-Like Illness , 2003, Pediatric Research.

[27]  G. Lipowsky,et al.  Interleukin-1 receptor antagonist and interleukin-6 for early diagnosis of neonatal sepsis 2 days before clinical manifestation , 1998, The Lancet.

[28]  J. Richman,et al.  Sample Entropy Statistics and Testing for Order in Complex Physiological Signals , 2007 .

[29]  R. D'Agostino,et al.  Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. , 2001, JAMA.

[30]  B P Kovatchev,et al.  Assessment of risk for severe hypoglycemia among adults with IDDM: validation of the low blood glucose index. , 1998, Diabetes care.

[31]  R J Sclabassi,et al.  Uncoupling and recoupling of autonomic regulation of the heart beat in pediatric septic shock. , 2001, Shock.

[32]  M. P. Griffin,et al.  Sample entropy analysis of neonatal heart rate variability. , 2002, American journal of physiology. Regulatory, integrative and comparative physiology.

[33]  H. Geijn,et al.  Spectral analysis of heart rate variability in spontaneously breathing very preterm infants , 1994, Acta paediatrica.

[34]  R. Simmons,et al.  Chronotropic effects of cytokines and the nitric oxide synthase inhibitor, L-NMMA, on cardiac myocytes. , 1994, Biochemical and biophysical research communications.

[35]  W. Poole,et al.  Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. , 2002, Pediatrics.

[36]  A. Strosberg,et al.  β-adrenergic receptor-dependent and -independent stimulation of adenylate cyclase is impaired during severe sepsis in humans , 1998, Intensive Care Medicine.

[37]  Pieter F F Wijn,et al.  Cardiovascular Fluctuations and Transfer Function Analysis in Stable Preterm Infants , 2003, Pediatric Research.

[38]  Michael R. Anderson,et al.  Advances in the therapy for sepsis in children. , 1997, Pediatric clinics of North America.

[39]  E. Marbán,et al.  Metabolic oscillations in heart cells. , 1995, Advances in experimental medicine and biology.

[40]  Sidney C. Smith,et al.  MARKERS OF INFLAMMATION AND CARDIOVASCULAR DISEASE: APPLICATION TO CLINICAL AND PUBLIC HEALTH PRACTICE: A STATEMENT FOR HEALTHCARE PROFESSIONALS FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION AND THE AMERICAN HEART ASSOCIATION , 2003 .

[41]  Pincus Sm,et al.  Approximate Entropy: A Regularity Measure for Fetal Heart Rate Analysis , 1992, Obstetrics and gynecology.

[42]  Urs E. Ruttimann,et al.  Decomplexification in critical illness and injury: Relationship between heart rate variability, severity of illness, and outcome , 1998, Critical care medicine.

[43]  F. Harrell,et al.  Heart rate characteristics: novel physiomarkers to predict neonatal infection and death. , 2005, Pediatrics.

[44]  T G Buchman,et al.  Experimental human endotoxemia increases cardiac regularity: results from a prospective, randomized, crossover trial. , 1996, Critical care medicine.

[45]  Z. Ba,et al.  Upregulation of Kupffer cell beta-adrenoceptors and cAMP levels during the late stage of sepsis. , 1998, Biochimica et biophysica acta.

[46]  J. Hanley,et al.  The meaning and use of the area under a receiver operating characteristic (ROC) curve. , 1982, Radiology.

[47]  R. Bone,et al.  Sepsis: a new hypothesis for pathogenesis of the disease process. , 1997, Chest.

[48]  Ronald M Harper,et al.  Development of Heart Rate Variation Over the First 6 Months of Life in Normal Infants , 1989, Pediatric Research.

[49]  S. Ben‐Haim,et al.  Development of baroreflex influences on heart rate variability in preterm infants. , 1998, Early human development.

[50]  T G Buchman,et al.  Uncoupling of biological oscillators: a complementary hypothesis concerning the pathogenesis of multiple organ dysfunction syndrome. , 1996, Critical care medicine.

[51]  W. Fifer,et al.  Maturational changes in heart rate and heart rate variability in low birth weight infants. , 2000, Developmental psychobiology.

[52]  J. Tyson,et al.  Early-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. , 1996, The Journal of pediatrics.

[53]  Douglas E. Lake,et al.  Renyi entropy measures of heart rate Gaussianity , 2006, IEEE Transactions on Biomedical Engineering.

[54]  J P Ornato,et al.  Use of the Acute Cardiac Ischemia Time-Insensitive Predictive Instrument (ACI-TIPI) To Assist with Triage of Patients with Chest Pain or Other Symptoms Suggestive of Acute Cardiac Ischemia: A Multicenter, Controlled Clinical Trial , 1998, Annals of Internal Medicine.

[55]  W. Knaus,et al.  Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. , 1992, Chest.

[56]  D Annane,et al.  Cardiac variability in critically ill adults: Influence of sepsis , 2001, Critical care medicine.

[57]  R. Cohen,et al.  Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. , 1981, Science.

[58]  G A McPherson,et al.  Heart Rate Spectral Analysis, Cardiac Norepinephrine Spillover, and Muscle Sympathetic Nerve Activity During Human Sympathetic Nervous Activation and Failure , 1994, Circulation.

[59]  P. Ridker.  Clinical application of C-reactive protein for cardiovascular disease detection and prevention. , 2003, Circulation.

[60]  R. D'Agostino,et al.  External validity of predictive models: a comparison of logistic regression, classification trees, and neural networks. , 2003, Journal of clinical epidemiology.

[61]  n Hodgma,et al.  Episodes of bradycardia during early infancy in the term‐born and preterm infant , 1994 .

[62]  J. Richman,et al.  Physiological time-series analysis using approximate entropy and sample entropy. , 2000, American journal of physiology. Heart and circulatory physiology.

[63]  P B Persson,et al.  Development of heart rate power spectra reveals neonatal peculiarities of cardiorespiratory control. , 1996, The American journal of physiology.