Abnormal heart rate characteristics are associated with neonatal mortality
Abnormal heart rate characteristics are associated with neonatal mortality
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DOI：
10.1203/01.pdr.0000119366.21770.9e
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发表时间：
2004-05-01
影响因子：
3.6
通讯作者：
Moorman, JR
中科院分区：
文献类型：
--
作者：
Griffin, MP;O'Shea, TM;Moorman, JR
评估新生儿重症监护病房的住院死亡风险可为医疗服务提供者提供重要信息，并且已经设计出疾病严重程度评分来提供死亡风险估计。疾病严重程度评分的计算很耗时，而且用于预测死亡的信息仅在出生后的12至24小时内收集。一种无创的连续测量方法，它利用整个住院期间收集的信息且无需数据录入，可能成本更低且信息量更大。我们先前已经表明，变异性降低和短暂减速等异常心率特征（HRC）伴随着新生儿疾病，如迟发性败血症。我们假设更频繁和严重的异常HRC与死亡风险增加有关。我们通过两种方式检验了这一假设。利用7日龄以上婴儿的数据，我们首先确定了HRC指数与下周死亡的关联。其次，我们设计了一个累积HRC评分，并确定了它与住院死亡的关联。685名患者中有37人死亡。主要发现是：1）HRC指数与随后7天的死亡具有高度显著的关联（受试者工作特征曲线下面积>0.7，p<0.001）；2）累积HRC与新生儿住院死亡率具有高度显著的关联（受试者工作特征曲线下面积>0.80，p<0.001）。在这两种分析中，HRC为出生体重、胎龄和出生后年龄增加了信息（p<0.01）。HRC指数提供了关于未来7天新生儿死亡风险的独立信息，累积HRC是对新生儿住院死亡风险的一种估计。
Estimating the risk of in-hospital mortality in the newborn intensive care unit can provide important information for healthcare providers, and illness severity scores have been devised to provide mortality risk estimates. Calculation of illness severity scores is time-consuming, and the information used to predict mortality is collected only for the first 12 to 24 h of life. A noninvasive continuous measure that uses information collected throughout the hospitalization and that requires no data entry could be less costly and more informative. We have previously shown that the abnormal heart rate characteristics (HRC) of reduced variability and transient decelerations accompany neonatal illness such as late-onset sepsis. We hypothesized that more frequent and severe abnormal HRC are associated with an increased risk of death. We tested this hypothesis in two ways. Using data on infants older than 7 d of age, we first determined the association of the HRC index with death in the next week. Second, we devised a cumulative HRC score and determined its association with in-hospital death. There were 37 deaths in the 685 patients. The major findings were 1) the HRC index showed highly significant association with death in the succeeding 7 d (receiver-operating characteristic area > 0.7, p < 0.001), and 2) the cumulative HRC was highly significantly associated with neonatal in-hospital mortality (receiver-operating characteristic area > 0.80, p < 0.001). In both analyses, HRC added information to birth weight, gestational age, and postnatal age (p < 0.01). The HRC index provides independent information about the risk of neonatal death in the upcoming 7 d, and the cumulative HRC is an estimate of the risk of in-hospital neonatal mortality.