J Clin Monit Comput - Complex signals bioinformatics: evaluation of heart rate characteristics monitoring as a novel risk marker for neonatal sepsis.

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Resumo

RPOSES: Heart rate characteristics monitoring for early detection of late-onset neonatal sepsis was first described in 2003. This technique, which uses mathematical methods to report the fold-increase in the risk of imminent neonatal sepsis, adds independent information to laboratory tests and clinical findings, and, in a large randomized trial, reduced NICU mortality of very low birth weight infants. Through re-analysis and new secondary analyses of published studies, we have systematically evaluated the utility of this new risk marker for screening the growing population of premature infants.METHODS: We followed the guidelines proposed by Hlatky et al. (Circulation, 119:2408-2416, 2009), reviewed past works, and re-analyzed data from 1,489 patients receiving conventional monitoring alone, 348 of whom had 488 episodes of proven sepsis, in the large randomized trial.RESULTS: Heart rate characteristics monitoring passed all phases of risk marker development from proof of concept to improvement of clinical outcomes. The predictiveness curve affirmed good calibration, and addition of the heart rate characteristics index to predictive models using standard risk factors favorably impacted the receiver operating characteristic curve area (increase of 0.030), continuous net reclassification index (0.389) and the integrated discrimination index (0.008), and compares well to other modern risk factors.CONCLUSION: Heart rate characteristics monitoring is a validated risk marker for sepsis in the NICU.

Resumo Limpo

rpose heart rate characterist monitor earli detect lateonset neonat sepsi first describ techniqu use mathemat method report foldincreas risk immin neonat sepsi add independ inform laboratori test clinic find larg random trial reduc nicu mortal low birth weight infant reanalysi new secondari analys publish studi systemat evalu util new risk marker screen grow popul prematur infantsmethod follow guidelin propos hlatki et al circul review past work reanalyz data patient receiv convent monitor alon episod proven sepsi larg random trialresult heart rate characterist monitor pass phase risk marker develop proof concept improv clinic outcom predict curv affirm good calibr addit heart rate characterist index predict model use standard risk factor favor impact receiv oper characterist curv area increas continu net reclassif index integr discrimin index compar well modern risk factorsconclus heart rate characterist monitor valid risk marker sepsi nicu

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