Heart rate characteristics: Novel physiomarkers to predict neonatal infection and death
Heart rate characteristics: Novel physiomarkers to predict neonatal infection and death
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DOI：
10.1542/peds.2004-2461
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发表时间：
2005-11-01
期刊：
影响因子：
8
通讯作者：
Moorman, JR
中科院分区：
文献类型：
--
作者：
Griffin, MP;Lake, DE;Moorman, JR
目的：利用心率变异性等生理标志物对受调节的生理过程进行监测，可能对亚急性、潜在灾难性疾病的早期诊断具有重要意义。在新生儿败血症早期，存在心率变异性降低和类似胎儿窘迫的短暂减速等生理标志物。本研究的目的是确定当观察到这些异常心率特征（HRC）时，败血症、尿路感染（UTI）和死亡的风险增加程度。
方法：我们对2个三级新生儿重症监护病房（NICU）的1022名婴儿进行了监测，其中458名婴儿为极低出生体重儿。我们根据经过验证的回归模型计算了HRC指数，该模型将心率时间序列和直方图的数学特征与疾病发作相关联。我们计算了按HRC测量分层的婴儿发生败血症、UTI和死亡等不良事件的风险。
结果：与低风险HRC测量值的婴儿相比，高风险HRC测量值的婴儿在次日发生不良事件的风险增加5 - 6倍，在下周增加3倍。与感染相关的实验室检查为HRC测量值提供了更多信息。与既无高风险HRC又无异常实验室检查结果的婴儿相比，同时具有高风险HRC和异常实验室检查结果的婴儿在次日发生不良事件的风险增加6 - 7倍。
结论：HRC是一种无创监测的生理标志物，可识别NICU中败血症、UTI和死亡风险较高的婴儿。
Objective. Monitoring of regulated physiologic processes using physiomarkers such as heart rate variability may be important in the early diagnosis of subacute, potentially catastrophic illness. Early in the course of neonatal sepsis, there are physiomarkers of reduced heart rate variability and transient decelerations similar to fetal distress. The goal of this study was to determine the degree of increased risk for sepsis, urinary tract infection (UTI), and death when these abnormal heart rate characteristics (HRC) were observed.Methods. We monitored 1022 infants at 2 tertiary care NICUs, 458 of whom were very low birth weight. We calculated an HRC index from validated regression models relating mathematical features of heart rate time series and histograms to episodes of illness. We calculated the risks for adverse events of sepsis, UTI, and death for infants stratified by HRC measurements.Results. Compared with infants with low-risk HRC measurements, infants with high-risk HRC measurements had 5- to 6-fold increased risk for an adverse event in the next day and 3-fold increased risk in the next week. Laboratory tests that were relevant to infection added information to HRC measurements. Infants with both high-risk HRC and abnormal laboratory tests had 6- to 7-fold increased risk for an adverse event in the next day compared with infants who had neither.Conclusion. HRC are noninvasively monitored physiomarkers that identify infants in the NICU who are at high risk for sepsis, UTI, and death.