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. 2023;120(5):548-557.
doi: 10.1159/000531118. Epub 2023 Jun 28.

Heart Rate Characteristics Monitoring for Late-Onset Sepsis in Preterm Infants: A Systematic Review

Hugo J Koppens  1   2 , W Onland  1   2 , Douwe H Visser  1   2 , Nerissa P Denswil  3 , Anton H van Kaam  1   2 , Claire A Lutterman  4
Affiliations

Heart Rate Characteristics Monitoring for Late-Onset Sepsis in Preterm Infants: A Systematic Review

Hugo J Koppens et al. Neonatology. 2023.

Abstract

Background: Early diagnosis of late-onset sepsis (LOS) and necrotizing enterocolitis (NEC) by monitoring heart rate characteristics (HRC) of preterm infants might reduce the risk of death and morbidities. We aimed to systematically assess the effects of HRC monitoring on death, LOS, and NEC.

Methods: A systematic search was performed in MEDLINE, Embase, Cochrane Library, and Web of Science.

Results: Fifteen papers were included in this review. Three of these papers reported results from the only identified randomized controlled trial (RCT). This RCT showed that HRC monitoring resulted in a small but significant reduction in mortality (absolute risk reduction 2.1% [95% confidence interval 0.01-4.14]) without any differences in neurodevelopmental impairment. The risk of bias was rated high due to performance and detection bias and failure to correct for multiple testing. Most diagnostic cohort studies showed high discriminating accuracy in predicting LOS but lacked sufficient quality and generalizability. No studies for the detection of NEC were identified.

Conclusion: Supported by multiple observational cohort studies, the RCT identified in this systematic review showed that HRC monitoring as an early warning system for LOS might reduce the risk of death in preterm infants. However, methodological weaknesses and limited generalizability do not justify implementation of HRC in clinical care. A large international RCT is warranted.

Keywords: Heart rate; Monitoring; Preterm infants; Sepsis.

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Conflict of interest statement

The authors have no possible conflicts of interest to declare.

Figures

Fig. 1.
Fig. 1.
Flow diagram search results November 18, 2022.
Fig. 2.
Fig. 2.
Methodological quality of the RCTs following the Cochrane Collaboration’s tool for assessing risk of bias. ☺, low risk; ☹, high risk; ?, unclear risk.
Fig. 3.
Fig. 3.
Methodological quality of observational studies following QUADAS-2 statement. ☺, low risk; ☹, high risk; ?, unclear risk. †Selected patient group/case-control design; ^threshold adapted; §reference test not likely to classify all sepsis episodes; $not all participants included in analyses; ‡all admissions or exclusively with bradycardia; !not continuously monitored; ⁺reference test not including clinical suspected sepsis episodes; and %quality assessment mainly reported in the original RCT [18].
See this image and copyright information in PMC

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