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

IF 2.6 3区医学 Q1 PEDIATRICS Neonatology Pub Date : 2023-01-01 Epub Date: 2023-06-28 DOI:10.1159/000531118

Hugo J Koppens, W Onland, Douwe H Visser, Nerissa P Denswil, Anton H van Kaam, Claire A Lutterman

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引用次数: 1

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.

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早产儿晚发败血症的心率特征监测：一项系统综述。

背景：通过监测早产儿的心率特征（HRC）来早期诊断晚发性败血症（LOS）和坏死性小肠结肠炎（NEC）可能会降低死亡和发病风险。我们旨在系统评估HRC监测对死亡、LOS和NEC的影响。方法：在MEDLINE、Embase、Cochrane图书馆和Web of Science上进行系统检索。结果：本综述共收录15篇论文。其中三篇论文报道了唯一确定的随机对照试验（RCT）的结果。该随机对照试验表明，HRC监测导致死亡率小幅但显著降低（绝对风险降低2.1%[95%置信区间0.01-4.14]），而神经发育障碍没有任何差异。由于性能和检测偏差以及未能纠正多次测试，偏差风险被评为高风险。大多数诊断性队列研究在预测LOS方面显示出很高的辨别准确性，但缺乏足够的质量和可推广性。没有发现检测NEC的研究。结论：在多项观察性队列研究的支持下，本系统综述中确定的随机对照试验表明，作为LOS的早期预警系统，HRC监测可能会降低早产儿的死亡风险。然而，方法上的弱点和有限的可推广性并不能证明在临床护理中实施HRC是合理的。有必要进行大规模的国际随机对照试验。

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来源期刊

Neonatology 医学-小儿科

CiteScore

0.60

自引率

4.00%

发文量

审稿时长

6-12 weeks

期刊介绍： This highly respected and frequently cited journal is a prime source of information in the area of fetal and neonatal research. Original papers present research on all aspects of neonatology, fetal medicine and developmental biology. These papers encompass both basic science and clinical research including randomized trials, observational studies and epidemiology. Basic science research covers molecular biology, molecular genetics, physiology, biochemistry and pharmacology in fetal and neonatal life. In addition to the classic features the journal accepts papers for the sections Research Briefings and Sources of Neonatal Medicine (historical pieces). Papers reporting results of animal studies should be based upon hypotheses that relate to developmental processes or disorders in the human fetus or neonate.

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