This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Infection is a major cause of death during the first month of life, contributing to 13-15% of all neonatal deaths. Mortality for neonatal sepsis may be as high as 50% for infants who are not treated. The early signs of sepsis in the newborn are nonspecific; therefore, many infants will undergo diagnostic studies and the initiation of treatment before the diagnosis has been determined. Better diagnostic tools that can provide timely and accurate diagnosis of neonatal sepsis will be of tremendous value. Prominent low-frequency heart rate oscillations, which could be related to the instability of neuroautonomic control, have been often observed prior to the diagnosis of sepsis. We have also observed that decreased heart rate and blood pressure variability, indicative of a loss of interconnections ('uncoupling'), between the neuroautonomic and cardiovascular systems correlate with increased severity of illness and less favorable outcome in critically ill infants with sepsis. We are developing heart rate variability indices that allow for early detection and prediction of clinical deterioration and monitoring the response to therapeutic intervention in the treatment of sepsis.
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