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Saving Babies from Sepsis

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CHARLOTESVILLE, Va. (Ivanhoe Newswire) - One in four babies will develop it and it can kill them. By the time doctors spot sepsis in newborns it can already be too late. Now, an infection detection device that's saving new lives.

For new parents Michael and Shelly, little Kinley came as a surprise.

"We weren't trying or anything," Shelly told Ivanhoe.

Another surprise, Kinley was born four months early weighing just one pound, five ounces.

"It was all new, I didn't know what to expect," says Michael.

Kinley was at high risk for sepsis, a severe blood infection that can spread throughout the body.

"If we detect it late it can be very, very damaging and even fatal." Karen Fairchild, M.D., a Neonatologist at the University of Virginia Health System, explained.

But finding the infection before it's too late can be tough.

"Once the baby shows signs of sepsis, they may already be very, very sick," Dr. Fairchild said.

Doctors at the University of Virginia developed the HeRO monitor to help pick up on the subtle signs early.

 "I really think this is revolutionary," Dr. Fairchild said.

Every hour it identifies changes in babies' heart rate patterns that happen early in sepsis, then creates a score from zero to seven.

"If your HeRO score is 1 you have exactly the average rate of illness. If your HeRO score is 2 you have twice the risk, if it's 3 you have three times the risk," Randall Moorman, M.D., a cardiologists at the University of Virginia Health System, explains.

In a study of 3,000 infants, those on the HeRO monitor had their risk of death cut by 20 percent.

Kinley's score was as high as five. She was given antibiotics and now all this new mom and dad have to worry about is parenthood.

Researchers at UVA have been working on the HeRO monitor for more than ten years and it's now being used in a handful of neonatal intensive care units around the country.

RESEARCH SUMMARY

BACKGROUND: Sepsis is a potentially life-threatening complication of an infection. While sepsis can happen to anyone, it's most common and most dangerous in people who are elderly or who have weakened immune systems. Sepsis occurs when chemicals released into the bloodstream to fight the infection trigger inflammation throughout the body. This inflammation creates microscopic blood clots that can block nutrients and oxygen from reaching organs, causing them to fail. If sepsis progresses to septic shock, blood pressure drops dramatically and the person may die. (Source: Mayo Clinic)

SEPSIS AND NEWBORNS: One in four babies will develop it and in newborns, it can be life-threatening. A number of different bacteria, including Escherichia coli (E.coli), Listeria, and certain strains of streptococcus, may cause neonatal sepsis. Neonatal sepsis may be categorized as early-onset or late-onset. Of newborns with early-onset sepsis, 85% present within 24 hours, 5% present at 24-48 hours, and a smaller percentage present within 48-72 hours. Onset is most rapid in premature newborns. Early-onset sepsis is associated with acquisition of microorganisms from the mother. Transplacental infection or an ascending infection from the cervix may be caused by organisms that colonize the mother's genitourinary (GU) tract; the neonate acquires the microorganisms as it passes through the colonized birth canal at delivery. (Source: Medscape)

Babies with late-onset neonatal sepsis get infected after delivery. The following increase an infant's risk of sepsis after delivery:

Having a catheter in a blood vessel for a long time

Staying in the hospital for an extended period of time

The signs of sepsis are non-specific and include: lethargy, a poor cry, poor feeding, fever, jaundice, poor perfusion, sclerema, poor weight gain, renal failure, cyanosis, tachypnea, chest retractions, grunt, apnea/gasping, fever, seizures, a blank look, high pitched cry, excessive crying/irritability, neck retraction, bulging fontanelle and seizures. A heart rate above 160 can also be an indicator of sepsis, this tachycardia can present up to 24 hours before the onset of other signs. (Source: MedlinePlus)

NEW TECHNOLOGY: Researchers at UVA developed the Heart Rate Observation System (HeRO monitor), which uses information gathered from the heart rate monitor to determine shifts in the heart rate on a continual basis. HeRO generates an hourly numeric score that quantifies the prevalence of abnormal patterns in each patient's heart rate. It provides real time display of the HeRO Score at multiple viewing stations located throughout the NICU. It's is non-invasive and requires no applied parts or new patient leads. Without the HeRO monitor, doctors and nurses have to rely on their own observations to detect early warning signs. (Source: Heroscore.com, UVA)

INTERVIEW

Karen D. Fairchild, M.D., Neonatologist at the University of Virginia Health System, talks about saving premature babies from infections.

What is Sepsis?

Dr. Fairchild: Sepsis is a severe bacterial infection that is very common in premature babies. About one out of four babies born very premature develop sepsis during their time in the NICU and if we catch it late it can be very, very severe and even fatal.

If it is severe but not fatal how can that affect them later in life?

Dr. Fairchild: Babies who have sepsis while they're in the NICU can have more risk for neurologic complications later so it's very important that we detect sepsis as early as possible. The difficulty is that in the early stages of sepsis the signs are very subtle and nonspecific. Things that the preemies do all the time could be an early sign of sepsis.

What are the kinds of bacteria that they can catch when they're that little?

Dr. Fairchild: The most common is staphylococci, the most severe is gram-negative bacteria like E. coli.

Are they still at risk at home?

Dr. Fairchild: Once the babies go home their risk for sepsis is very low. The high risk time for premature babies is while they're in the NICU since they have very immature immune systems and a lot of intensive care interventions like breathing tubes and IV's that make them very high risk for infection.

Are there other tests besides the HERO that show you when the baby is at risk for an infection?

Dr. Fairchild: Before we had the HERO monitor, the conventional way to manage babies was to wait until they showed signs of infection and then do some blood tests, for example, a white blood cell count, and a blood culture to look for bacteria in the bloodstream. The problem with that approach is that once the baby shows signs of sepsis he or she may already be very, very sick. The benefit of the HERO monitor is that we can detect sepsis earlier, sometimes even before the baby shows any signs and we can treat earlier which will improve outcomes.

How do you treat an infection like sepsis?

Dr. Fairchild: Bacterial infection needs to be treated with antibiotics, which is different than viral infections. Babies who are very sick with sepsis and shock also need fluid and medications to support their blood pressure.

What was the idea behind the monitor?

Dr. Fairchild: We monitor vital signs including heart rate in all babies in the intensive care unit. But when we look at the heart rate it only gives us a little bit of information. What the HERO monitor does is it takes all that data that we're already collecting on every baby in the unit and it puts it through a computer, a mathematical formula, and it looks for patterns that are associated with early stages of sepsis.

Is it something you can easily see on the monitor?

Dr. Fairchild: You can see it on the HERO monitor but you can't see it on the regular monitor. If I see that a baby's heart rate is a hundred and fifty that's normal, but if the HERO monitor sees that the heart rate is staying at a hundred and fifty and not having normal accelerations or having abnormal decelerations in heart rate then the HERO score goes up. That indicates that the heart rate patterns are abnormal and that sometime in the next twelve to twenty four hours the baby may have sepsis.

What should parents know about screening their baby? Are there other tests they should be asking for?

Dr. Fairchild: We do a lot of tests in premature babies. They not only undergo continuous monitoring of all their vital signs but we do blood tests regularly when they're very small and then once they get more stable we just do blood tests as needed. The thing about sepsis is if we wait until they look or act septic and then send a blood culture and start antibiotics that could be too late. We use the HERO monitor which doesn't require any extra contact with the baby, it just takes what we already have and analyzes it and gives the nurses and doctors a score that tells us the chance that baby is going to have sepsis in the next day. When the HERO score goes up the nurse will let me know that I need to look at that baby very carefully. Of the forty five babies in the NICU here it's hard to know which one is in the early stages of sepsis and the HERO score helps to get me to the right bedside at the right time, to decide whether a baby needs tests and treatment.

Can you tell me about Kynleigh?

Dr. Fairchild: Kenly is a baby whose now about eleven weeks old. She was born at twenty three weeks, which is very early and so her chance of having a severe infection or sepsis was about fifty percent at that stage. She is now six weeks from her due date so she is still in an incubator but she is learning how to breast feed, and she's breathing on her own. She actually had an episode back in early June where her HERO score went up and she looked like she might be in the early stage of sepsis. We sent some blood tests and started antibiotics and she did really well.

What was her highest level?

Dr. Fairchild: I believe it went up to five.

What does that mean?

Dr. Fairchild: That's really high. Less than one is normal and that's reassuring. If a baby starts going up to two or three I know that I need to pay close attention and think about sepsis or other things and decide whether to start antibiotics. With Kenly, between the HERO score and her lab tests we were fairly certain she had sepsis.

Is she on medication right now?

Dr. Fairchild: She was back then but she's now off antibiotics and doing fine.

What do you think would have happened to her without the HERO monitor?

Dr. Fairchild: It could have been an extra twelve or twenty four hours until we picked up sepsis. She might have survived, but not done quite as well. The important thing in the randomized clinical trial, the HERO trial, is that three thousand small premature infants in nine NICU's across the United States were randomized and half of them the nurses and doctors could see the HERO score and the other half the HERO score was monitored but nobody could see it. In the babies where the clinicians saw the HERO score there was a more than twenty percent reduction in mortality. If you look at a NICU that has forty eight very low birthweight infants and they're all undergoing HERO monitoring one extra baby would survive because of the HERO monitor.

What is the highest score?

Dr. Fairchild? Seven is the maximum.

Have you ever seen a baby as high as seven?

Dr. Fairchild: Yes. We have a baby right now in the NICU whose score has been very high in the last day but because of the HERO monitor, the infection was picked up earlier.

Do you consider this as a game changer?

Dr. Fairchild: Yes. The clinical trial was published last year and there are now almost twenty NICU's across the United States using the HERO monitor. I think it's going to take a lot of education to teach clinicians how to use it properly, but I really think this is revolutionary.

FOR MORE INFORMATION, PLEASE CONTACT:

Meghan Bradley
UVA Health System
Marketing Communications
(434) 760-3715
mbradley@virginia.edu

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