Serife Kurul (Netherlands)
Erasmus MC, University Medical Center-Sophia Children’s Hospital NeonatologyAuthor Of 1 Presentation
INTRODUCING HEART RATE VARIABILITY MONITORING COMBINED WITH BIOMARKER SCREENING INTO A LEVEL IV NICU: A PROSPECTIVE IMPLEMENTATION STUDY
Abstract
Backgrounds:
Late-onset neonatal sepsis (LONS) is a major complication in preterm neonates. Early recognition, by means of heart rate variability (HRV) monitoring, could help to guide early therapy and thereby improve outcome. The aim of this study was to investigate the association between the implementation of a local HRV-monitoring guideline in a level-IV NICU on mortality, measures of sepsis severity, frequency of sepsis testing and antibiotic usage among very preterm neonates.
Methods
In January 2018 a local guideline was implemented for early detection of LONS 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; pre-implementation period Jan 2016-Dec 2017 (n=515), and post-implementation period Jan 2018-Jun 2020 (n=620)).
Results:
In the study period, a total of 811 blood cultures in 473 neonates were withdrawn. Of these episodes, 490 (60.4%) were classified as sepsis. In the pre-implementation period, death within 10 days of start of the sepsis episode occurred in 39 (10.3%) episodes and in the post-implementation period it occurred in 34 (7.6%) episodes (P = 0.21). The nSOFA course during a sepsis episode was significantly lower in the post-implementation group (P = 0.01). We observed no statistically significant difference in number of blood cultures drawn and in antibiotic usage between the two periods.
Conclusions/Learning Points:
Implementing HRV-monitoring with determination of inflammatory biomarkers might help identify patients with sepsis sooner, resulting in improved outcome, without an increased use of antibiotics or blood cultures withdrawals.
Presenter of 1 Presentation
INTRODUCING HEART RATE VARIABILITY MONITORING COMBINED WITH BIOMARKER SCREENING INTO A LEVEL IV NICU: A PROSPECTIVE IMPLEMENTATION STUDY
Abstract
Backgrounds:
Late-onset neonatal sepsis (LONS) is a major complication in preterm neonates. Early recognition, by means of heart rate variability (HRV) monitoring, could help to guide early therapy and thereby improve outcome. The aim of this study was to investigate the association between the implementation of a local HRV-monitoring guideline in a level-IV NICU on mortality, measures of sepsis severity, frequency of sepsis testing and antibiotic usage among very preterm neonates.
Methods
In January 2018 a local guideline was implemented for early detection of LONS 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; pre-implementation period Jan 2016-Dec 2017 (n=515), and post-implementation period Jan 2018-Jun 2020 (n=620)).
Results:
In the study period, a total of 811 blood cultures in 473 neonates were withdrawn. Of these episodes, 490 (60.4%) were classified as sepsis. In the pre-implementation period, death within 10 days of start of the sepsis episode occurred in 39 (10.3%) episodes and in the post-implementation period it occurred in 34 (7.6%) episodes (P = 0.21). The nSOFA course during a sepsis episode was significantly lower in the post-implementation group (P = 0.01). We observed no statistically significant difference in number of blood cultures drawn and in antibiotic usage between the two periods.
Conclusions/Learning Points:
Implementing HRV-monitoring with determination of inflammatory biomarkers might help identify patients with sepsis sooner, resulting in improved outcome, without an increased use of antibiotics or blood cultures withdrawals.