Introducing heart rate variability monitoring combined with biomarker screening into a level IV NICU

Introducing heart rate variability monitoring combined with biomarker screening into a level IV NICU: a prospective implementation study

Kurul, Şerife (Erasmus MC)
van Ackeren, Nicky (Erasmus MC)
Goos, T.G. (TU Delft Medical Instruments & Bio-Inspired Technology; Erasmus MC)
Ramakers, Christian R.B. (Erasmus MC)
Been, Jasper V. (Erasmus MC)
Kornelisse, René F. (Erasmus MC)
Reiss, Irwin K.M. (Erasmus MC)
Simons, Sinno H.P. (Erasmus MC)
Taal, H. Rob (Erasmus MC)

2022

The aim of this study was to investigate the association between the implementation of a local heart rate variability (HRV) monitoring guideline combined with determination of inflammatory biomarkers and mortality, measures of sepsis severity, frequency of sepsis testing, and antibiotic usage, among very preterm neonates. In January 2018, a guideline was implemented for early detection of late-onset neonatal sepsis using HRV monitoring combined with determination of inflammatory biomarkers. Data on all patients admitted with a gestational age at birth of < 32 weeks were reviewed in the period January 2016–June 2020 (n = 1,135; n = 515 pre-implementation, n = 620 post-implementation). Outcomes of interest were (sepsis-related) mortality, sepsis severity (neonatal sequential organ failure assessment (nSOFA)), sepsis testing, and antibiotic usage. Differences before and after implementation of the guideline were assessed using logistic and linear regression analysis for binary and continuous outcomes respectively. All analyses were adjusted for gestational age and sex. Mortality within 10 days of a sepsis episode occurred in 39 (10.3%) and 34 (7.6%) episodes in the pre- and post-implementation period respectively (P = 0.13). The nSOFA course during a sepsis episode was significantly lower in the post-implementation group (P = 0.01). We observed significantly more blood tests for determination of inflammatory biomarkers, but no statistically significant difference in number of blood cultures drawn and in antibiotic usage between the two periods.

Conclusion: Implementing HRV monitoring with determination of inflammatory biomarkers might help identify patients with sepsis sooner, resulting in reduced sepsis severity, without an increased use of antibiotics or number of blood cultures.

Neonatology
Neonatal sepsis
Heart rate variability monitoring
Interleukin-6
C-reactive protein
Procalcitonin

http://resolver.tudelft.nl/uuid:3da54102-8e6c-4a83-a2b3-0058f3f2c01c

https://doi.org/10.1007/s00431-022-04534-4

0340-6199

European Journal of Pediatrics, 181 (9), 3331-3338

Institutional Repository

journal article

© 2022 Şerife Kurul, Nicky van Ackeren, T.G. Goos, Christian R.B. Ramakers, Jasper V. Been, René F. Kornelisse, Irwin K.M. Reiss, Sinno H.P. Simons, H. Rob Taal