Partner publication

Recently our partner Erasmus MC Rotterdam published their first article in which they share their experiences with HeRO Symphony.

Association of inflammatory biomarkers with subsequent clinical course in suspected late onset sepsis in preterm neonates
Şerife Kurul, Sinno H. P. Simons, Christian R. B. Ramakers, Yolanda B. De Rijke, René F. Kornelisse, Irwin K. M. Reiss & H. Rob Taal. Critical Care volume 25, Article number: 12 (2021)

What is HeRO?

Neonatal monitoring systems lack the ability to provide early warnings of patient distress. This is what makes HeRO different. HeRO identifies subtle irregularities in heart rate variability that occur hours and days prior to patient deterioration and provides an early warning of patient distress, including sepsis1,2, NEC2,3, UTI1,4, meningitis4, respiratory decompensation2,5,6, brain pathology7,8,9, and death1.

Unlike any other monitoring technology available, HeRO has been proven in the most rigorous scientific fashion to improve survival: use of the HeRO score led to a 22% mortality reduction in very low birthweight infants 10.

How does HeRO work?

Cytokines are the mediators of the inflammatory response which have effects throughout the body. One of those effects is characteristic abnormal heart rate patterns that occur during the early stage of infection. HeRO is able to identify these patterns by analysing data that is already being collected by the physiological monitor and renders a score (i.e. the HeRO score) every hour that shows the risk of infection in the next 24 hours11. A rising HeRO score often precedes clinical signs and symptoms by several hours to days.

If antibiotics can be started earlier, the infection can be treated before it goes systematic and causes all sorts of problems. There is a large body of literature demonstrating that delays in antibiotic administration can increase mortality and morbidity12,13,14,15,16.

HeRO is a non-invasive tool to help anticipate rapid declines in neonates. It uses the data that is already being collected by the existing physiological monitor – meaning there are no additional leads needed and there is no extra patient contact required.

HeRO is used to:

  • Continuously acquire an ECG signal or heart rate data from an existing physiological monitor;
  • Identify and determine the length of time between individual heart beats (the R-R Interval);
  • Calculate a set of measures from these R-R Intervals to characterize the heart rate pattern;
  • Compute an “index” based on the degree of decelerations and reduced baseline variability in these patterns;
  • Calculate the HeRO score, which expresses the index as a fold-increase risk of sepsis relative to the overall NICU population, and;
  • Provide this information to clinicians in a timely and intuitive fashion.

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1 Heart Rate Characteristics: Novel Physiomarkers to Predict Neonatal Infection and Death, Griffin, et al. Pediatrics 2005.
2 Infection and Other Clinical Correlates of Abnormal Heart Rate Characteristics in Preterm Infants. Sullivan et al, JPeds 2014.
3 Abnormal heart rate characteristics before clinical diagnosis of necrotizing enterocolitis. Stone et al. Journal of Perinatology 2018.
4 Urinary tract infection, meningitis, and septicemia in VLBW infants enrolled in a heart rate characteristics monitoring trial. Weitkamp, et al. ABSTRACT: PAS 2018.
5 Predictive monitoring for respiratory decompensation leading to urgent unplanned intubation in the neonatal intensive care unit. Clark, et al. Pediatric Research 2013.
6 Predicting Extubation Outcomes-A Model Incorporating Heart Rate Characteristics Index. Goel et al, JPeds 2018.
7 Abnormal heart rate characteristics are associated with abnormal neuroimaging and outcomes in extremely low birth weight infants. Fairchild, et al. J Perinatology 2014.
8 Depressed Heart Rate Variability is Associated with Abnormal EEG, MRI, and Death in Neonates with Hypoxic Ischemic Encephalopathy. Vergales, et al. Am J Perinatol 2013.
9 Heart rate characteristics and neurodevelopmental outcome in very low birth weight infants. Addison K et al. J Perinatology 2009.
10 Mortality Reduction by Heart Rate Characteristic Monitoring in Very Low Birth Weight Neonates: A Randomized Trial. Moorman et al. J Pediatrics 2011.
11 HeRO monitoring to reduce mortality in NICU patients. Fairchild KD, Aschner JL. P Research and Reports in Neonatology 2012.
12 Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Kumar et al. Crit Care Med 2006.
13 Efficacy of adequate early antibiotic therapy in ventilator-associated pneumonia: influence of disease severity. Clec’h et al. Intensive Care Med 2004.
14 Outcomes analysis of delayed antibiotic treatment for hospital-acquired Staphylococcus aureus bacteremia. Lodise et al. Clin Infect Dis 2003.
15 Antibiotic treatment delay and outcome in acute bacterial meningitis. Køster-Rasmussen et al. J Infect 2008.
16 Septicemia mortality reduction in neonates in a heart rate characteristics monitoring trial. Fairchild et al. Pediatr Res 2013.

For your reference we have a complete literature list available at: HeRo Score