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Heart Rate Characteristics

From EverybodyWiki Bios & Wiki



Heart Rate Characteristics (HRC) are a specific set of Heart Rate Variability (HRV) metrics useful in assessing the inflammatory status of patients in a Neonatal ICU (NICU). Abnormal HRC are associated with cytokines, and have been shown to predict infections including sepsis, urinary tract infection, meningitis, and necrotizing enterocolitis. In a large randomized controlled trial, HRC monitoring was shown to improve survival and other outcomes.

Heart Rate Characteristics Index

Heart Rate Variability (HRV) is altered in the presence of cytokines including IL-1B, IL-6, IL-12p40 and KC in mice.[1][2]. These abnormal heart rate patterns were observed prior to the diagnosis of sepsis among premature patients in a Neonatal Intensive Care Unit, and a specific set of HRV metrics called Heart Rate Characteristics including standard deviation, sample entropy, and sample asymmetry were developed to predict neonatal sepsis[3]. The HRC Index represents the fold-increase risk in a patient being diagnosed with sepsis in the next 24 hours compared to average risk[4].

Clinical Significance

The HRC Index is predictive of infections among NICU patients including sepsis[5][6][7][8][9], necrotizing enterocolitis (NEC)[10][11], urinary tract infection (UTI) and meningitis[12]. In a study of need for unplanned intubation among NICU patients, the HRC Index was the best predictor in univariate analysis[13]. The HRC Index was also found to be a predictor of extubation success in multiple studies[14][15]. Elevated HRC Index is associated with neuro trauma including Moderate/Severe EEG findings, higher grade IVH, MRI white matter damage, and poor neurodevelopmental outcomes[16][17][18][19]. The HRC Index is predictive of death among NICU patients[20][21][22].

Outcomes

A pragmatic randomized controlled trial was conducted where 3,003 very low birth weight (VLBW) infants were randomized to receive standard of care, or standard of care plus display of the HRC Index to clinicians. The HRC-display arm patients experienced a 22% reduction in all-cause mortality[23], a 40% reduction in mortality after infection[24], and reduced length of stay after controlling for increased survival[25]. The extremely low birth weight (ELBW) patients from those study centers that performed follow-up visits were found to have reduced mortality and reduced mortality-or-severe-cerebral-palsy at 18-22 months corrected age[26]

References

  1. ↑ Fairchild, Karen D.; Saucerman, Jeffrey J.; Raynor, Laura L.; Sivak, Joseph A.; Xiao, Yuping; Lake, Douglas E.; Moorman, J. Randall (October 2009). "Endotoxin depresses heart rate variability in mice: cytokine and steroid effects". American Journal of Physiology-Regulatory, Integrative and Comparative Physiology. 297 (4): R1019–R1027. doi:10.1152/ajpregu.00132.2009. ISSN 0363-6119.
  2. ↑ Fairchild, Karen D.; Srinivasan, Varadamurthy; Randall Moorman, J.; Gaykema, Ronald P. A.; Goehler, Lisa E. (February 2011). "Pathogen-induced heart rate changes associated with cholinergic nervous system activation". American Journal of Physiology-Regulatory, Integrative and Comparative Physiology. 300 (2): R330–R339. doi:10.1152/ajpregu.00487.2010. ISSN 0363-6119.
  3. ↑ Griffin, M. P. (2005-11-01). "Heart Rate Characteristics: Novel Physiomarkers to Predict Neonatal Infection and Death". PEDIATRICS. 116 (5): 1070–1074. doi:10.1542/peds.2004-2461. ISSN 0031-4005.
  4. ↑ Fairchild, Karen D.; O'Shea, T. Michael (September 2010). "Heart Rate Characteristics: Physiomarkers for Detection of Late-Onset Neonatal Sepsis". Clinics in Perinatology. 37 (3): 581–598. doi:10.1016/j.clp.2010.06.002. ISSN 0095-5108.
  5. ↑ Griffin, M Pamela; O'Shea, T Michael; Bissonette, Eric A; Harrell, Frank E; Lake, Douglas E; Moorman, J Randall (June 2003). "Abnormal Heart Rate Characteristics Preceding Neonatal Sepsis and Sepsis-Like Illness". Pediatric Research. 53 (6): 920–926. doi:10.1203/01.pdr.0000064904.05313.d2. ISSN 0031-3998.
  6. ↑ Griffin, M. P.; Lake, D. E.; Moorman, J. R. (2005-04-01). "Heart Rate Characteristics and Laboratory Tests in Neonatal Sepsis". PEDIATRICS. 115 (4): 937–941. doi:10.1542/peds.2004-1393. ISSN 0031-4005.
  7. ↑ Moorman, J.R.; Lake, D.E.; Griffin, M.P. (January 2006). "Heart Rate Characteristics Monitoring for Neonatal Sepsis". IEEE Transactions on Biomedical Engineering. 53 (1): 126–132. doi:10.1109/tbme.2005.859810. ISSN 0018-9294.
  8. ↑ Griffin, M Pamela; Lake, Douglas E; O'Shea, T Michael; Moorman, J Randall (February 2007). "Heart Rate Characteristics and Clinical Signs in Neonatal Sepsis". Pediatric Research. 61 (2): 222–227. doi:10.1203/01.pdr.0000252438.65759.af. ISSN 0031-3998.
  9. ↑ Moorman, J Randall; Delos, John B; Flower, Abigail A; Cao, Hanqing; Kovatchev, Boris P; Richman, Joshua S; Lake, Douglas E (October 2011). "Cardiovascular oscillations at the bedside: early diagnosis of neonatal sepsis using heart rate characteristics monitoring". Physiological Measurement. 32 (11): 1821–1832. doi:10.1088/0967-3334/32/11/s08. ISSN 0967-3334.
  10. ↑ Stone, M L; Tatum, P M; Weitkamp, J-H; Mukherjee, A B; Attridge, J; McGahren, E D; Rodgers, B M; Lake, D E; Moorman, J R; Fairchild, K D (2013-05-30). "Abnormal heart rate characteristics before clinical diagnosis of necrotizing enterocolitis". Journal of Perinatology. 33 (11): 847–850. doi:10.1038/jp.2013.63. ISSN 0743-8346.
  11. ↑ Sullivan, Brynne A.; Fairchild, Karen D. (August 2015). "Predictive monitoring for sepsis and necrotizing enterocolitis to prevent shock". Seminars in Fetal and Neonatal Medicine. 20 (4): 255–261. doi:10.1016/j.siny.2015.03.006. ISSN 1744-165X.
  12. ↑ Weitkamp, Joern-Hendrik; Aschner, Judy L.; Carlo, Wallly A.; Bancalari, Eduardo; Perez, Jose A.; Navarrete, Cristina T.; Schelonka, Robert L.; Whit Walker, M.; Porcelli, Peter; O’Shea, Thomas M.; Palmer, Charles (2019-12-04). "Meningitis, urinary tract, and bloodstream infections in very low birth weight infants enrolled in a heart rate characteristics monitoring trial". Pediatric Research. 87 (7): 1226–1230. doi:10.1038/s41390-019-0701-4. ISSN 0031-3998.
  13. ↑ Clark, Matthew T.; Vergales, Brooke D.; Paget-Brown, Alix O.; Smoot, Terri J.; Lake, Douglas E.; Hudson, John L.; Delos, John B.; Kattwinkel, John; Moorman, J. Randall (2012-11-08). "Predictive monitoring for respiratory decompensation leading to urgent unplanned intubation in the neonatal intensive care unit". Pediatric Research. 73 (1): 104–110. doi:10.1038/pr.2012.155. ISSN 0031-3998.
  14. ↑ Alonzo, Corrie J.; Fairchild, Karen D. (2017-12-26). "Dexamethasone effect on heart rate variability in preterm infants on mechanical ventilation". Journal of Neonatal-Perinatal Medicine. 10 (4): 425–430. doi:10.3233/npm-16157. ISSN 1934-5798.
  15. ↑ Goel, Nitin; Chakraborty, Mallinath; Watkins, William John; Banerjee, Sujoy (April 2018). "Predicting Extubation Outcomes—A Model Incorporating Heart Rate Characteristics Index". The Journal of Pediatrics. 195: 53–58.e1. doi:10.1016/j.jpeds.2017.11.037. ISSN 0022-3476.
  16. ↑ Addison, K; Griffin, M P; Moorman, J R; Lake, D E; O'Shea, T M (2009-06-25). "Heart rate characteristics and neurodevelopmental outcome in very low birth weight infants". Journal of Perinatology. 29 (11): 750–756. doi:10.1038/jp.2009.81. ISSN 0743-8346.
  17. ↑ Fairchild, K D; Sinkin, R A; Davalian, F; Blackman, A E; Swanson, J R; Matsumoto, J A; Lake, D E; Moorman, J R; Blackman, J A (2014-02-20). "Abnormal heart rate characteristics are associated with abnormal neuroimaging and outcomes in extremely low birth weight infants". Journal of Perinatology. 34 (5): 375–379. doi:10.1038/jp.2014.18. ISSN 0743-8346.
  18. ↑ Kayton, Allyson; DeGrazia, Michele; Sharpe, Elizabeth; Smith, Denise; Perez, Jose A.; Weiss, Michael D. (2020-01-27). "Correlation Between Heart Rate Characteristic Index Score and Severity of Brain Injury in Neonates With Hypoxic-Ischemic Encephalopathy". Advances in Neonatal Care. Publish Ahead of Print. doi:10.1097/anc.0000000000000686. ISSN 1536-0903.
  19. ↑ Vergales, Brooke; Zanelli, Santina; Matsumoto, Julie; Goodkin, Howard; Lake, Douglas; Moorman, J.; Fairchild, Karen (2013-12-17). "Depressed Heart Rate Variability is Associated with Abnormal EEG, MRI, and Death in Neonates with Hypoxic Ischemic Encephalopathy". American Journal of Perinatology. 31 (10): 855–862. doi:10.1055/s-0033-1361937. ISSN 0735-1631.
  20. ↑ Griffin, M Pamela; O'Shea, T Michael; Bissonette, Eric A; Harrell, Frank E; Lake, Douglas E; Moorman, J Randall (May 2004). "Abnormal Heart Rate Characteristics Are Associated with Neonatal Mortality". Pediatric Research. 55 (5): 782–788. doi:10.1203/01.pdr.0000119366.21770.9e. ISSN 0031-3998.
  21. ↑ Griffin, M. P. (2005-11-01). "Heart Rate Characteristics: Novel Physiomarkers to Predict Neonatal Infection and Death". PEDIATRICS. 116 (5): 1070–1074. doi:10.1542/peds.2004-2461. ISSN 0031-4005.
  22. ↑ Sullivan, Brynne A.; McClure, Christina; Hicks, Jamie; Lake, Douglas E.; Moorman, J. Randall; Fairchild, Karen D. (July 2016). "Early Heart Rate Characteristics Predict Death and Morbidities in Preterm Infants". The Journal of Pediatrics. 174: 57–62. doi:10.1016/j.jpeds.2016.03.042. ISSN 0022-3476.
  23. ↑ Moorman, Joseph Randall; Carlo, Waldemar A.; Kattwinkel, John; Schelonka, Robert L.; Porcelli, Peter J.; Navarrete, Christina T.; Bancalari, Eduardo; Aschner, Judy L.; Whit Walker, Marshall; Perez, Jose A.; Palmer, Charles (December 2011). "Mortality Reduction by Heart Rate Characteristic Monitoring in Very Low Birth Weight Neonates: A Randomized Trial". The Journal of Pediatrics. 159 (6): 900–906.e1. doi:10.1016/j.jpeds.2011.06.044. ISSN 0022-3476.
  24. ↑ Fairchild, Karen D.; Schelonka, Robert L.; Kaufman, David A.; Carlo, Waldemar A.; Kattwinkel, John; Porcelli, Peter J.; Navarrete, Cristina T.; Bancalari, Eduardo; Aschner, Judy L.; Walker, M. Whit; Perez, Jose A. (2013-08-13). "Septicemia mortality reduction in neonates in a heart rate characteristics monitoring trial". Pediatric Research. 74 (5): 570–575. doi:10.1038/pr.2013.136. ISSN 0031-3998.
  25. ↑ Swanson, Jonathan R.; King, William E.; Sinkin, Robert A.; Lake, Douglas E.; Carlo, Waldemar A.; Schelonka, Robert L.; Porcelli, Peter J.; Navarrete, Christina T.; Bancalari, Eduardo; Aschner, Judy L.; Perez, Jose A. (July 2018). "Neonatal Intensive Care Unit Length of Stay Reduction by Heart Rate Characteristics Monitoring". The Journal of Pediatrics. 198: 162–167. doi:10.1016/j.jpeds.2018.02.045. ISSN 0022-3476.
  26. ↑ Schelonka, Robert L.; Carlo, Waldemar A.; Bauer, Charles R.; Peralta-Carcelen, Myriam; Phillips, Vivien; Helderman, Jennifer; Navarrete, Christina T.; Moorman, J. Randall; Lake, Douglas E.; Kattwinkel, John; Fairchild, Karen D. (April 2020). "Mortality and Neurodevelopmental Outcomes in the Heart Rate Characteristics Monitoring Randomized Controlled Trial". The Journal of Pediatrics. 219: 48–53. doi:10.1016/j.jpeds.2019.12.066. ISSN 0022-3476.


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