Abnormal heart rate characteristics preceding neonatal sepsis and sepsis-like illness
Abnormal heart rate characteristics preceding neonatal sepsis and sepsis-like illness
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DOI：
10.1203/01.pdr.0000064904.05313.d2
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发表时间：
2003-06-01
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
迟发型新生儿败血症是发病和死亡的重要原因，早期发现可能是有益的。此前，我们发现变异性降低和短暂减速的异常心率特征（HRC）在单个新生儿重症监护病房（NICU）的新生儿败血症及类败血症疾病病程早期出现。我们假设这一发现可推广到其他NICU。我们前瞻性地收集了两个NICU中所有住院超过7天的婴儿的临床数据并持续测量其RR间期。我们将败血症及类败血症疾病发作定义为促使医生进行血培养并开始使用抗生素的急性临床恶化情况。在弗吉尼亚大学NICU的316名新生儿组成的衍生队列中开发了一个产生HRC指数的预测统计模型，然后将其应用于维克森林大学NICU的317名新生儿组成的验证队列。在衍生队列中，101名婴儿出现了155次败血症及类败血症疾病发作，在验证队列中，93名婴儿出现了118次。在验证队列中，HRC指数1）与即将发生的败血症及类败血症疾病具有高度显著的相关性（受试者工作特征曲线下面积为0.75，p < 0.001），并且2）在预测败血症及类败血症疾病时，对出生体重、胎龄和出生后天数等人口统计学信息有显著的补充作用（p < 0.001）。持续的HRC监测是一种普遍有效且可能有用的新生儿败血症及类败血症疾病早期诊断的无创工具。
Late-onset neonatal sepsis is a significant cause of morbidity and mortality, and early detection could prove beneficial. Previously, we found that abnormal heart rate characteristics (HRC) of reduced variability and transient decelerations occurred early in the course of neonatal sepsis and sepsis-like illness in infants in a single neonatal intensive care unit (NICU). We hypothesized that this finding can be generalized to. other NICUs. We prospectively collected clinical data and continuously measured RR intervals in all infants in two NICUs who stayed for >7 d. We defined episodes of sepsis and sepsis-like illness as acute clinical deteriorations that prompted physicians to obtain blood cultures and start antibiotics. A predictive statistical model yielding an HRC index was developed on a derivation cohort of 316 neonates in the University of Virginia NICU and then applied to the validation cohort of 317 neonates in the Wake Forest University NICU. In the derivation cohort, there were 155 episodes of sepsis and sepsis-like illness in 101 infants, and in the validation cohort, there were 118 episodes in 93 infants. In the validation cohort, the HRC index 1) showed highly significant association with impending sepsis and sepsis-like illness (receiver operator characteristic area 0.75, p < 0.001) and 2) added significantly to the demographic information of birth weight, gestational age, and days of postnatal age in predicting sepsis and sepsis-like illness (p < 0.001). Continuous HRC monitoring is a generally valid and potentially useful noninvasive tool in the early diagnosis of neonatal sepsis and sepsis-like illness.