FANNP 25TH NATIONAL NNP SYMPOSIUM: CLINICAL UPDATE AND REVIEW
A3a From Zero to HeRO: Reducing Mortality from Sepsis Jamie Fletcher-Hicks, MSN, APRN, NNP-BC Neonatal Nurse Practitioner University of Virginia Medical Center, Charlottesville, VA The speaker has signed a disclosure form and indicated she has no significant financial interest or relationship with the companies or the manufacturer(s) of any commercial product and/or service that will be discussed as part of this presentation.
Session Summary Late onset sepsis continues to end the lives of many very low birth weight (VLBW) infants. Abnormal heart rate characteristics present prior to clinical signs of infection. The use of the FDA-approved HeRO (Heart Rate Observation) monitor reduces sepsis mortality through earlier detection in the VLBW population and is just the beginning of improving outcomes through predictive monitoring.
Session Objectives Upon completion of this presentation, the participant will be able to: •
discuss sepsis as a cause of morbidity/mortality in neonates and the importance of early detection;
•
understand abnormal heart rate characteristics (HRCs) in the presence of sepsis;
•
review how development and testing of Heart Rate Observation (HeRO) monitor quantifies HRCs and decreases mortality from sepsis due to earlier detection and treatment;
•
understand the future of predictive monitoring.
References Cuenca, A.G., Wynn, J.L., Moldawer, L.L. & Levy, O. (2013). Role of innate immunity in neonatal infection. American Journal of Perinatology, 30(2): 105-12. Fairchild, K.D., Sinkin, R.A., Davalian, F., Blackman, A.E. et al. (2014). Abnormal heart rate characteristics are associated with abnormal neuroimaging and outcomes in extremely low birth weight infants. Journal of Perinatology, 34(5): 375-9. Fairchild, K.D. & O’Shea, T.M. (2010). Heart rate characteristics: Physiomarkers for detection of late-onset neonatal sepsis. Clinics in Perinatology, 37(3): 581-98. Johnson, T.J., Patel, A.L, Jegier, B.J., Engstrom, J.L. & Meier, P.P. (2013). Cost of morbidities in very low birth weight infants. Journal of Pediatrics, 162(2): 243-49. Kenner, C. & Lott, J.W. (2007). Comprehensive neonatal care: An interdisciplinary approach. St. Louis, MO: Saunders Elsevier. Moorman, J.R., Carlo, W.A., Kattwinkel, J., et al. (2011). Mortality reduction by heart rate characteristic monitoring in very low birth weight neonates: A randomized trial. Journal of Pediatrics, 159(6): 900-6 e1.
A3a: FROM ZERO TO HeRO: REDUCING MORTALITY FROM SEPSIS
Page 1 of 11
FANNP 25TH NATIONAL NNP SYMPOSIUM: CLINICAL UPDATE AND REVIEW
Ozkan, H., Cetinkaya, M., Koksal, N., Celebi, S. & Hacımustafaoglu, M. (2014). Culture-proven neonatal sepsis in preterm infants in a neonatal intensive care unit over a 7-year period: Coagulase-negative Staphylococcus as the prodominant pathogen. Pediatric Institute, 56(1): 60-6. DOI: 10.1111/ped.12218. Stoll, B.J., Hansen, N., Fanaroff, A.A., et al. (2002). Late-onset sepsis in very low birth weight neonates: The experience of the NICHD Neonatal Research Network. Pediatrics, 110(2 Pt 1): 285-91. Sullivan, B.A., Grice, S.M., Lake, D.E, Moorman, J.R. & Fairchild, K.D. (2014). Infection and other clinical correlates of abnormal heart rate characteristics in preterm infants. Jounal of Pediatrics, 164(4): 775-80. Stone, M.L., Tatum, P.M., Weitkamp, J.H., Mukherjee, A.B, et al. (2013). Abnormal heart rate characteristics before clinical diagnosis of necrotizing enterocolitis. Journal of Perinatology, 33(11): 847-50. Vergales, B.D., Paget-Brown, A.O., Lee, H., et al. (2013). Accurate automated apnea analysis in preterm infants. American Journal of Perinatology, 31(02): 157-162, DOI: 10.1055/s-0033-1343769.
Session Outline See presentation handout on the following pages.
A3a: FROM ZERO TO HeRO: REDUCING MORTALITY FROM SEPSIS
Page 2 of 11
FANNP 25TH NATIONAL NNP SYMPOSIUM: CLINICAL UPDATE AND REVIEW
Is This Baby Getting Sick?
From Zero to HeRO: Reducing Mortality From Sepsis
Jamie Fletcher Hicks, RN, MSN, NNP-BC Neonatal Nurse Practitioner University of Virginia Health System Neonatal Intensive Care Unit
The HeRO monitor helps predict infection so we can start antibiotics before this baby……
….becomes this baby.
Objectives:
Sepsis by Numbers:
•
Brief discussion of sepsis as cause of morbidity/mortality in neonates and the importance of early detection
•
•
Understand abnormal heart rate characteristics (HRCs) in the presence of sepsis
•
Late onset neonatal sepsis (LONS): >3 days
•
Very Low Birth Weight (VLBW,
