Heart rate characteristic index monitoring for bloodstream infection in an NICU: a 3-year experience.
Heart rate characteristic index monitoring for bloodstream infection in an NICU: a 3-year experience.
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DOI：
10.1136/archdischild-2015-309210
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发表时间：
2016-07
期刊：
影响因子：
--
通讯作者：
Wynn JL
中科院分区：
文献类型：
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作者：
Coggins SA;Weitkamp JH;Grunwald L;Stark AR;Reese J;Walsh W;Wynn JL
新生儿重症监护病房（NICU）婴儿血流感染（BSI）是一个常见的与不良预后相关的问题。监测异常心率特征（HRC）可能会降低婴儿死亡率，提醒临床医生败血症成为临床明显。HRC评分由医疗预测科学公司（Medical Predictive Science Corporation）的HRC （HeRO）监测系统获取，并由床边工作人员录入电子病历。我们回顾性分析了30个月期间（2010年1月1日至2012年6月30日）医疗记录中每天两次的新生儿HRC评分，这些婴儿是在Vanderbilt Monroe Carell Jr.儿童医院的NICU中出生的。在研究期间，我们确定了符合CDC标准的晚发型BSI（出生后3天）的婴儿。在研究期间，我们记录了2384名婴儿的127673个HRC评分。我们确定了46名患有BSI的婴儿。虽然8%（9701/ 127673）的HRC评分≥2,1%（1387/ 127673）的HRC评分≥5，但只有5%的HRC评分≥2的患者和9%的HRC评分≥5的患者观察到BSI（在任何时候）。在BSI婴儿中，5/46（11%）至少有一个HRC评分≥5,17/46（37%）在评估前48小时内至少有一个HRC评分≥2，导致首次血培养阳性。在我们的单中心回顾性研究中，升高的HRC评分检测BSI的能力有限。在HRC评分显著升高的婴儿住院期间，BSI很少发生。
Blood stream infection (BSI) among Neonatal Intensive Care Unit (NICU) infants is a frequent problem associated with poor outcomes. Monitoring for abnormal heart rate characteristics (HRC) may decrease infant mortality by alerting clinicians to sepsis before it becomes clinically apparent. HRC scores were acquired using the HRC (HeRO) monitor system from Medical Predictive Science Corporation and entered into the electronic medical record by bedside staff. We retrospectively analyzed HRC scores recorded twice daily in the medical record during a 30-month period (January 1, 2010 through June 30, 2012) for infants in the NICU at the Monroe Carell Jr. Children’s Hospital at Vanderbilt. We identified infants that met CDC criteria for late-onset BSI (>3 days of life) during the study period. During the study period, we recorded 127,673 HRC scores from 2384 infants. We identified 46 infants with BSI. Although 8% (9701/127,673) of the HRC scores were ≥2 and 1% (1387/127,673) were ≥5, BSI (at any time) was observed in just 5% of patients with HRC scores ≥2, and 9% of patients with HRC scores ≥5. Of infants with BSI, 5/46 (11%) had at least one HRC score ≥5 and 17/46 (37%) had at least one score ≥2 recorded in the 48 hour period prior to the evaluation that resulted in the first positive blood culture of the episode. In our single center retrospective study, elevated HRC scores had limited ability to detect BSI. BSI was infrequent at any time during hospitalization in infants with significantly elevated HRC scores.