Key result
Heart rate characteristics monitoring reduces mortality by ~2% in preterm infants.
Why the study?
Early diagnosis of late-onset sepsis and necrotizing enterocolitis in preterm infants by monitoring heart rate characteristics might reduce death and morbidities, but evidence is uncertain.
Does heart rate characteristics monitoring reduce death, late-onset sepsis, and necrotizing enterocolitis in preterm infants?
Systematic Review
Does heart rate characteristics monitoring reduce death, late-onset sepsis, and necrotizing enterocolitis in preterm infants?
Absolute Risk Reduction: 2.1 (95% CI 0.01–4.14)
Absolute Risk Reduction: 2.1%
HRC monitoring may reduce mortality in preterm infants by acting as an early warning system for late-onset sepsis, but current evidence is limited by methodological weaknesses.
May support HRC monitoring in preterm care; confirms mortality benefit yet methodological weaknesses leave other outcomes open.
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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Koppens et al. (2023) conducted a systematic review in Late-onset sepsis and necrotizing enterocolitis. Heart rate characteristics (HRC) monitoring was evaluated on Mortality (ARR 2.1%, 95% CI 0.01-4.14). Heart rate characteristics monitoring resulted in a small but significant reduction in mortality (absolute risk reduction 2.1%; 95% CI 0.01-4.14) in preterm infants.
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