Meningitis, urinary tract, and bloodstream infections in very low birth weight infants enrolled in a heart rate characteristics monitoring trial.

Abstract

Background:Displaying heart rate characteristics (HRC) scores was associated with lower sepsis-associated mortality in very low birth weight (VLBW) infants in a multicenter randomized controlled trial (HeRO trial).Objective:To test whether HRC indices rise before diagnosis of urinary tract infection (UTI) or meningitis, with and without concomitant BSI.Design/Methods:Blood, urine and cerebrospinal fluid (CSF) culture data after 3 days of age and within 120 days of study enrollment were analyzed from 2,989 VLBW infants. The HRC index was analyzed 12h prior to positive cultures compared to 36h prior, using paired signed rank tests.Results:UTI, meningitis, and BSI was diagnosed in 10%, 2%, and 24% of infants respectively. The mean hourly HRC index was significantly higher 12h prior to diagnosis of UTI and BSI compared to 36h prior (UTI 2.07 versus 1.81; BSI 2.62 versus 2.25, both p<0.0001). The baseline HRC index was higher for meningitis, compared to UTI or BSI, but without a statistically significant rise in the day prior to meningitis diagnosis.Conclusions:In a large cohort of VLBW infants enrolled in the HeRO trial, the HRC index increased in the 24h period prior to diagnosis of UTI and BSI, but not meningitis.