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Published on: November 22, 2013
Early Heart Rate Characteristics Predict Death and Morbidities in Preterm Infants
Brynne A Sullivan1, Christina McClure1, Jamie Hicks1
1Department of Pediatrics, University of Virginia, Charlottesville, VA.
Insights
Early heart rate characteristics (HRC) index, or HeRO score, effectively predicts mortality and morbidities in very low birth weight infants, performing comparably to established scores.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Cardiovascular Physiology
Background:
- Predicting outcomes in very low birth weight (VLBW) infants is crucial for clinical management.
- Established illness severity scores have limitations in predicting mortality and morbidities.
- Early physiological markers may offer improved predictive capabilities.
Purpose of the Study:
- To evaluate the predictive performance of an early heart rate characteristics (HRC) index, known as the HeRO score, in VLBW infants.
- To compare the HeRO score's ability to predict death and major morbidities against established neonatal illness severity scores.
Main Methods:
- Calculated average HRC index within 24 hours (aHRC-24h) and 7 days (aHRC-7d) of birth for VLBW infants (2004-2014).
- Compared aHRC-24h and aHRC-7d with Score for Neonatal Acute Physiology (SNAP-II) and Clinical Risk Indicator for Babies (CRIB-II).
- Assessed prediction of mortality, late-onset septicemia, necrotizing enterocolitis, bronchopulmonary dysplasia, severe intraventricular hemorrhage, and severe retinopathy of prematurity.
Main Results:
- All four scores, including aHRC-24h and aHRC-7d, predicted mortality and severe intraventricular hemorrhage.
- The HeRO score demonstrated significant odds ratios for mortality, with aHRC-7d showing a higher predictive value (OR 2.61).
- High aHRC-7d, SNAP-II, and CRIB-II were associated with bronchopulmonary dysplasia, and aHRC-7d with late-onset septicemia.
Conclusions:
- Heart rate characteristics assessed early after birth provide a favorable predictive tool for mortality and morbidities in VLBW infants.
- The HeRO score offers a valuable, non-invasive method for risk stratification in neonatal intensive care.
- Further research may refine the HeRO score's application in clinical decision-making for VLBW infants.
Objectives:
To determine whether an early heart rate characteristics (HRC) index (HeRO score), measured in the first day and week after birth predicts death and morbidities compared with established illness severity scores.
Study Design:
For all very low birth weight infants in a single neonatal intensive care unit from 2004-2014, the average first day HRC index was calculated within 24 hours of birth (aHRC-24h) and the average first week HRC index within 7 days of birth (aHRC-7d). The Score for Neonatal Acute Physiology (SNAP-II) and Clinical Risk Indicator for Babies (CRIB-II) were calculated when data were available. The aHRC was compared with the SNAP-II and CRIB-II for predicting death, late-onset septicemia, necrotizing enterocolitis, bronchopulmonary dysplasia, severe intraventricular hemorrhage, or severe retinopathy of prematurity.
Results:
All 4 scores were associated with death and severe intraventricular hemorrhage (P < .01). The OR and 95% CI for every 1-point increase in aHRC for predicting mortality, adjusted for gestational age, was 1.59 (1.25-2.00) for aHRC-24h and 2.61 (1.58-4.33) for aHRC-7d. High aHRC-7d, SNAP-II, and CRIB-II were associated with bronchopulmonary dysplasia (P < .001). High aHRC-7d was associated with late-onset septicemia (P < .05). None of the scores predicted necrotizing enterocolitis or severe retinopathy of prematurity.
Conclusions:
HRC assessed in the first day or first week after birth compares favorably to established risk scores to predict death and morbidities in very low birth weight infants.
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