Abstract
Background
Monitoring of heart rate characteristics (HRC) index may improve outcomes of late-onset neonatal sepsis (LOS) through early detection. We aimed at describing the association between LOS and elevated HRC index.
Methods
This single-center retrospective case–control study included neonates who presented with blood culture-proven hospital-acquired LOS. Controls were matched to cases (ratio 1:2) based on gestational age, postnatal age, and birthweight. We compared the highest HRC indexes in the 48 h preceding blood culture sampling in LOS cases to the highest HRC indexes at the same postnatal days in controls.
Results
In 59 LOS cases and 123 controls, an HRC index > 2 was associated with LOS (OR 7.1, 95% CI 2.6–19.0). Sensitivity and specificity of an HRC index > 2 to predict LOS were 53% (32/59) and 79% (98/123). Sensitivity increased from 25% in infants born > 32 weeks to 76% in infants born < 28 weeks. Specificity decreased from 97% in infants > 32 weeks to 63% in those born < 28 weeks.
Conclusions
An increase of HRC index > 2 has a significant association with the diagnosis of LOS, supporting the use of HRC monitoring to assist early detection of LOS. Clinicians using HRC monitoring should be aware of its diagnostic accuracy and limitations in different gestational age groups.
Impact
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There is a paucity of data regarding the predictive value of heart rate characteristics (HRC) monitoring for early diagnosis of late-onset neonatal sepsis (LOS) in daily clinical practice.
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Monitoring of heart rate characteristics provides valuable information to assist the early diagnosis of LOS across all gestational age groups.
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However, the strong influence of gestational age on positive and negative predictive values adds complexity to the interpretation of HRC indexes.
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Acknowledgements
Eric Giannoni is supported by the Leenaards Foundation.
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L.R.: Conception or design of the work; data acquisition; data analysis and interpretation; drafting the article; critical revision of the article and final approval of the version to be published. A.-S.R.: Conception or design of the work; data analysis and interpretation; drafting the article; critical revision of the article and final approval of the version to be published. P.B.: Data analysis and interpretation; drafting the article; critical revision of the article and final approval of the version to be published. C.S.: Data acquisition; drafting the article and final approval of the version to be published. S.A.: Conception or design of the work; data analysis and interpretation; drafting the article; critical revision of the article and final approval of the version to be published. E.G.: Conception or design of the work; data acquisition; data analysis and interpretation; drafting the article; critical revision of the article and final approval of the version to be published.
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Rio, L., Ramelet, AS., Ballabeni, P. et al. Monitoring of heart rate characteristics to detect neonatal sepsis. Pediatr Res 92, 1070–1074 (2022). https://doi.org/10.1038/s41390-021-01913-9
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DOI: https://doi.org/10.1038/s41390-021-01913-9
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