TY - JOUR
T1 - Cardiorespiratory signatures of necrotizing enterocolitis
T2 - a 4-NICU study of very low birth weight infants
AU - Kausch, Sherry L.
AU - Vesoulis, Zachary A.
AU - Travers, Colm P.
AU - Taveras, Carie
AU - Benz, Rachel
AU - Duncan, Amanda
AU - Gummadi, Angela K.S.
AU - Krahn, Katy N.
AU - Sahni, Rakesh
AU - Isler, Joseph
AU - Ambalavanan, Namasivayam
AU - Randall Moorman, J.
AU - Lake, Douglas E.
AU - Fairchild, Karen D.
AU - Sullivan, Brynne A.
N1 - Publisher Copyright:
© The Author(s) 2025.
PY - 2025
Y1 - 2025
N2 - Background: Necrotizing enterocolitis (NEC) is a disorder in very low birth weight (VLBW, <1500 g) infants, associated with significant morbidity and mortality. Earlier detection of NEC may improve outcomes. We hypothesized that NEC’s physiological signature resembles that of sepsis and that our model developed for sepsis, the Pulse Oximetry Warning System (POWS), would also predict NEC. Objectives: Assess relationships between continuous heart rate (HR) and oxygen saturation (SpO2) features and NEC risk, and evaluate POWS performance for predicting medical and surgical NEC. Methods: In a retrospective multicenter analysis, we studied VLBW infants at four level IV NICUs, identifying cases of late-onset sepsis (LOS) and NEC (Bell stages 2 or 3). Using HR and SpO2 data, we calculated features and POWS scores and assessed associations with NEC and LOS risk. Results: Among 3914 infants evaluated, 5% had NEC and 13% had LOS. Cardiorespiratory data analysis showed that HR/SpO2 patterns had similar risk associations with NEC and LOS. POWS AUC was 0.758 for NEC, 0.804 for sepsis, 0.791 for NEC or LOS, and 0.808 for NEC requiring surgery. Conclusion: NEC shares a cardiorespiratory signature with LOS. POWS predicted NEC with a dynamic rise before clinical diagnosis. Impact: A cardiorespiratory early warning score analyzing heart rate and oxygen saturation, trained to predict late-onset sepsis within 24h across, predicts necrotizing enterocolitis. Heart rate and oxygen saturation features had the same patterns of association with necrotizing enterocolitis as sepsis.
AB - Background: Necrotizing enterocolitis (NEC) is a disorder in very low birth weight (VLBW, <1500 g) infants, associated with significant morbidity and mortality. Earlier detection of NEC may improve outcomes. We hypothesized that NEC’s physiological signature resembles that of sepsis and that our model developed for sepsis, the Pulse Oximetry Warning System (POWS), would also predict NEC. Objectives: Assess relationships between continuous heart rate (HR) and oxygen saturation (SpO2) features and NEC risk, and evaluate POWS performance for predicting medical and surgical NEC. Methods: In a retrospective multicenter analysis, we studied VLBW infants at four level IV NICUs, identifying cases of late-onset sepsis (LOS) and NEC (Bell stages 2 or 3). Using HR and SpO2 data, we calculated features and POWS scores and assessed associations with NEC and LOS risk. Results: Among 3914 infants evaluated, 5% had NEC and 13% had LOS. Cardiorespiratory data analysis showed that HR/SpO2 patterns had similar risk associations with NEC and LOS. POWS AUC was 0.758 for NEC, 0.804 for sepsis, 0.791 for NEC or LOS, and 0.808 for NEC requiring surgery. Conclusion: NEC shares a cardiorespiratory signature with LOS. POWS predicted NEC with a dynamic rise before clinical diagnosis. Impact: A cardiorespiratory early warning score analyzing heart rate and oxygen saturation, trained to predict late-onset sepsis within 24h across, predicts necrotizing enterocolitis. Heart rate and oxygen saturation features had the same patterns of association with necrotizing enterocolitis as sepsis.
UR - https://www.scopus.com/pages/publications/105025057706
U2 - 10.1038/s41390-025-04631-8
DO - 10.1038/s41390-025-04631-8
M3 - Article
C2 - 41402639
AN - SCOPUS:105025057706
SN - 0031-3998
JO - Pediatric research
JF - Pediatric research
ER -