Heart rate characteristics: physiomarkers for detection of late-onset neonatal sepsis.
Heart rate characteristics: physiomarkers for detection of late-onset neonatal sepsis.
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DOI：
10.1016/j.clp.2010.06.002
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发表时间：
2010-09
影响因子：
2.1
通讯作者：
O'Shea TM
中科院分区：
文献类型：
--
作者：
Fairchild KD;O'Shea TM
在出现明显且可能具有灾难性的临床症状之前早期发现迟发型新生儿败血症，是新生儿医学的一个重要目标。败血症会引起一系列众所周知的生理变化，包括血压、呼吸、体温和心率异常，以及不太为人所知的心率变异性变化。虽然新生儿重症监护病房（NICU）的患者经常或持续监测生命体征，但在败血症早期，这些参数的变化很细微，使用传统的NICU监测工具难以解读。一种新的工具——心率特征连续监测，现已可供临床使用。最近的研究已经确定，产科医生长期用于识别胎儿窘迫的两种心率特征异常——心率变异性降低和短暂减速——在NICU患者败血症病程早期就会出现，往往在疾病的临床症状之前。通过对数百名NICU患者的心电图数据进行数学建模，得出了一个心率特征（HRC）指数，该指数代表新生儿在接下来24小时内被诊断为临床败血症或经培养证实的败血症的风险增加倍数。对3000名患者进行的一项多中心随机临床试验将在2010年完成，该试验旨在研究持续HRC监测对极早产极低出生体重婴儿预后的影响。对败血症和其他疾病过程中异常HRC的机制以及自主神经系统功能调节的进一步研究，将为这项令人兴奋的新技术的其他应用提供启示。
Early detection of late onset neonatal sepsis, prior to obvious and potentially catastrophic clinical signs, is an important goal in neonatal medicine. Sepsis causes a well-known series of physiologic changes including abnormalities of blood pressure, respiration, temperature, and heart rate, and less well-known changes in heart rate variability. While vital signs are frequently or continuously monitored in NICU patients, changes in these parameters are subtle in the early phase of sepsis and difficult to interpret using traditional NICU monitoring tools. A new tool, continuous monitoring of heart rate characteristics, is now available for clinical use. Recent research has established that two abnormalities of heart rate characteristics which have long been used by obstetricians to identify fetal compromise - reduced heart rate variability and transient decelerations - occur early in the course of sepsis in NICU patients, often before clinical signs of illness. Through mathematical modeling of electrocardiogram data from hundreds of NICU patients, a heart rate characteristics (HRC) index was derived that represents the fold increase in risk that a neonate will be diagnosed with clinical or culture-proven sepsis within the next 24 hours. The impact of continuous HRC monitoring on outcomes in preterm very low birthweight infants is the subject of a multicenter randomized clinical trial of 3000 patients which will be complete in 2010. Further research into mechanisms of abnormal HRC and regulation of autonomic nervous system function in sepsis and other disease processes will shed light on additional applications of this exciting new technology.
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影响因子：
22.8
作者：
Cohen, H;Matar, MA;Kotler, M
通讯作者：
Kotler, M
DOI：
10.1152/ajpregu.00132.2009
发表时间：
2009-10-01
影响因子：
2.8
作者：
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通讯作者：
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作者：
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通讯作者：
Lee, Liang-Shong
影响因子：
3.6
作者：
Griffin, MP;O'Shea, TM;Moorman, JR
通讯作者：
Moorman, JR
影响因子：
3.1
作者：
Dunser, Martin W;Hasibeder, Walter R
通讯作者：
Hasibeder, Walter R