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.

中文翻译：

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早产儿迟发性败血症的心率特征监测：系统评价。

背景通过监测早产儿的心率特征（HRC）早期诊断迟发性败血症（LOS）和坏死性小肠结肠炎（NEC）可能会降低死亡和发病的风险。我们的目的是系统评估 HRC 监测对死亡、LOS 和 NEC 的影响。方法 在 MEDLINE、Embase、Cochrane 图书馆和 Web of Science 中进行系统检索。结果 本综述纳入 15 篇论文。其中三篇论文报告了唯一确定的随机对照试验 (RCT) 的结果。该随机对照试验表明，HRC 监测使死亡率小幅但显着降低（绝对风险降低 2.1% [95% 置信区间 0.01-4.14]），且神经发育障碍没有任何差异。由于性能和检测偏差以及未能纠正多重测试，偏差风险被评为高。大多数诊断队列研究在预测 LOS 方面表现出较高的判别准确性，但缺乏足够的质量和普遍性。未发现检测 NEC 的研究。结论 在多项观察性队列研究的支持下，本系统评价中确定的随机对照试验表明，HRC 监测作为 LOS 早期预警系统可能会降低早产儿的死亡风险。然而，方法学上的弱点和有限的普遍性并不能证明在临床护理中实施 HRC 是合理的。有必要进行大型国际随机对照试验。