Cross-Correlation of Heart Rate and Oxygen Saturation in Very Low Birthweight Infants: Association with Apnea and Adverse Events

Background Analysis of subtle vital sign changes could facilitate earlier treatment of acute inflammatory illnesses. We previously showed that high cross-correlation of heart rate and oxygen saturation (XCorr-HR-SpO2) occurs in some very low birthweight (VLBW) infants with sepsis, and hypothesized that this corresponds to apnea. Methods In 629 VLBW infants, we analyzed XCorr-HR-SpO2 in relation to central apnea with bradycardia and desaturation (ABD), BD with or without central apnea (BD), and percent time in periodic breathing (PB) throughout the neonatal intensive care unit (NICU) stay (75 infant-years). We reviewed 100 days with extremely high XCorr-HR-SpO2 (>0.7) and control days for clinical associations. Next, we identified all cases of late-onset septicemia (LOS) and necrotizing enterocolitis (NEC) and analyzed change in XCorr-HR-SpO2 before diagnosis. Results Mean XCorr-HR-SpO2 was ∼0.10, and increasing XCorr-HR-SpO2 was associated with increasing ABD, BD, and PB (correlation coefficients >0.93). Days with maximum XCorr-HR-SpO2 >0.7 were more likely to have an adverse event than control days (49% versus 13%). In 93 cases of LOS or NEC, there was a 67% increase in XCorr-HR-SpO2 in the 24-hour period prior to diagnosis compared with the previous day (p < 0.01). Conclusion High XCorr-HR-SpO2 is associated with apnea and adverse events including LOS and NEC.

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Urinary tract infections in very low birthweight infants: A two-center analysis of microbiology, imaging and heart rate characteristics

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-200513 ◽

2020 ◽

pp. 1-8

Author(s):

N. Aviles-Otero ◽

M. Ransom ◽

J. Weitkamp ◽

J.R. Charlton ◽

B.A. Sullivan ◽

...

Keyword(s):

Heart Rate ◽

Urinary Tract ◽

Continuous Monitoring ◽

Low Birthweight ◽

Very Low Birthweight ◽

Vlbw Infants ◽

Before And After ◽

Very Low Birthweight Infants ◽

The Mean ◽

Tract Infections

BACKGROUND: Increased understanding of characteristics of urinary tract infection (UTI) among very low birthweight infants (VLBW) might lead to improvement in detection and treatment. Continuous monitoring for abnormal heart rate characteristics (HRC) could provide early warning of UTIs. OBJECTIVE: Describe the characteristics of UTI, including HRC, in VLBW infants. METHODS: We reviewed records of VLBW infants admitted from 2005–2010 at two academic centers participating in a randomized clinical trial of HRC monitoring. Results of all urine cultures, renal ultrasounds (RUS), and voiding cystourethrograms (VCUG) were assessed. Change in the HRC index was analyzed before and after UTI. RESULTS: Of 823 VLBW infants (27.7±2.9 weeks GA, 53% male), 378 had > / = 1 urine culture obtained. A UTI (≥10,000 CFU and >five days of antibiotics) was diagnosed in 80 infants, (10% prevalence, mean GA 25.8±2.0 weeks, 76% male). Prophylactic antibiotics were administered to 29 (36%) infants after UTI, of whom four (14%) had another UTI. Recurrent UTI also occurred in 7/51 (14%) of infants not on uroprophylaxis after their first UTI. RUS was performed after UTI in 78%, and hydronephrosis and other major anomalies were found in 19%. A VCUG was performed in 48% of infants and 18% demonstrated vesicoureteral reflux (VUR). The mean HRC rose and fell significantly in the two days before and after diagnosis of UTI. CONCLUSIONS: UTI was diagnosed in 10% of VLBW infants, and the HRC index increased prior to diagnosis, suggesting that continuous HRC monitoring in the NICU might allow earlier diagnosis and treatment of UTI.

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1034 GLUCOSE INTOLERANCE IN VERY LOW BIRTHWEIGHT (VLBW) INFANTS

Pediatric Research ◽

10.1203/00006450-197804001-01040 ◽

1978 ◽

Vol 12 ◽

pp. 536-536

Author(s):

Yvonne E Vaucher ◽

Grant Morrow

Keyword(s):

Glucose Intolerance ◽

Low Birthweight ◽

Very Low Birthweight ◽

Vlbw Infants

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HOW TO PROLONG LACTATION IN MOTHERS OF VLBW INFANTS

PEDIATRICS ◽

10.1542/peds.83.5.a42a ◽

1989 ◽

Vol 83 (5) ◽

pp. A42-A42

Author(s):

Student

Keyword(s):

Developing Countries ◽

Low Birthweight ◽

Randomised Trial ◽

Control Group ◽

Very Low Birthweight ◽

Vlbw Infants ◽

Skin Contact ◽

Very Low Birthweight Infants ◽

Skin To Skin

We have carried out a randomised trial [of skin to skin contact with their mothers] among babies of less than 1500 gm . . . Mothers using skin to skin contact lactated for four weeks longer on average than the control group . . . [This maneuver] can enjoyably be offered to very low birthweight infants especially in developing countries where mother's lactation is vital.

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SCREENING THYROXINE LEVEL AND DEVELOPMENTAL OUTCOME IN VERY LOW BIRTHWEIGHT(VLBW) INFANTS. 546

Pediatric Research ◽

10.1203/00006450-199604001-00567 ◽

1996 ◽

Vol 39 ◽

pp. 94-94

Author(s):

Cynthia H Meyers-Seifer ◽

Pamela G Almeida ◽

Sharon Capuano ◽

Betty R Vohr

Keyword(s):

Low Birthweight ◽

Developmental Outcome ◽

Very Low Birthweight ◽

Vlbw Infants ◽

Thyroxine Level

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GROWTH OF VERY LOW BIRTHWEIGHT (VLBW) INFANTS: EFFECTS OF ACIDOSIS, CALORIC INTAKE AND HYPONATREMIA

Pediatric Research ◽

10.1203/00006450-197404000-00674 ◽

1974 ◽

Vol 8 (4) ◽

pp. 452-452 ◽

Cited By ~ 2

Author(s):

D M Willis ◽

N R Roy ◽

G W Chance ◽

I Ackerman ◽

E Park ◽

...

Keyword(s):

Low Birthweight ◽

Caloric Intake ◽

Very Low Birthweight ◽

Vlbw Infants

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Parents' estimation of psychomotor development in very low birthweight (VLBW) infants

Early Human Development ◽

10.1016/0378-3782(95)01645-j ◽

1995 ◽

Vol 42 (2) ◽

pp. 131-139 ◽

Cited By ~ 5

Author(s):

Andrea Heiser ◽

Ingrid Grimmer ◽

Boris Metze ◽

Michael Obladen

Keyword(s):

Low Birthweight ◽

Psychomotor Development ◽

Very Low Birthweight ◽

Vlbw Infants

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Protocol for the Lactoferrin Infant Feeding Trial (LIFT): a randomised trial of adding lactoferrin to the feeds of very-low birthweight babies prior to hospital discharge

BMJ Open ◽

10.1136/bmjopen-2018-023044 ◽

2018 ◽

Vol 8 (10) ◽

pp. e023044 ◽

Cited By ~ 5

Author(s):

Andrew Martin ◽

Alpana Ghadge ◽

Paolo Manzoni ◽

Kei Lui ◽

Rebecca Brown ◽

...

Keyword(s):

Brain Injury ◽

Hospital Discharge ◽

Low Birthweight ◽

Late Onset ◽

Randomised Trial ◽

Control Group ◽

Bovine Lactoferrin ◽

Very Low Birthweight ◽

End Point ◽

Late Onset Sepsis

IntroductionVery-low birthweight (VLBW, <1500 g) infants comprise about 1%–1.4% of all births in high-income countries. Every year, about 3000 VLBW babies in Australia and New Zealand receive intensive care. Many die or else survive with severe brain injury, retinopathy, late-onset sepsis or necrotising enterocolitis (NEC), each of which carries substantial risk of disability.Methods and analysisThis trial tests whether adding bovine lactoferrin (bLF) to feeds in VLBW infants improves (1) survival to hospital discharge free from brain injury, late-onset sepsis, NEC and treated retinopathy of prematurity (primary composite end point); (2) each component of the primary composite end point and (3) time to reach full enteral feeds, number of blood transfusions, chronic lung disease and length of hospital stay. It includes a cost-effectiveness analysis of bLF in improving survival free from major morbidity, and evaluates the effect of bLF on survival and developmental outcomes at 24 to 36 months corrected gestational age.This is a multicentre, two-arm, randomised trial comparing the treatment group receiving bLF added to breast milk or formula milk daily (up to 250 mg/kg/day bLF) versus the control group receiving no bLF supplementation. The intervention is administered until 34 completed weeks corrected gestation or for 2 weeks, whichever is longer, or until discharge home, if earlier. The target sample size of 1500 participants yields 85% power, at the two-sided 5% level significance, to detect a difference in proportions meeting the primary outcome assuming the true probability is 74% in controls and 80.5% in the bLF group.Ethics and disseminationThis protocol was approved by Northern Sydney Local Human Research Ethics Committee in January 2017 (Version 2.0, Reference 1003-118M) and other relevant ethics committees. The findings of the trial will be disseminated through peer-reviewed journals and conference presentations.Trial registration numberACTRN12611000247976; Pre-results.

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