The HeRO Whiteboard Introduction

In today’s episode, we give a general overview of HeRO and the value that it provides to the modern neonatal intensive care unit.

The HeRO Whiteboard Episode 1 – An Overview

In this overview video, we present a general overview of HeRO and the topics for the successive videos in this series.

The HeRO Whiteboard Episode 2 – Cytokines & HRC

In this episode, we discuss the links between infection, inflammation, cytokines, and abnormal heart rate variability (HRV). All of which led to development of HeRO, a system that identifies abnormal heart rate characteristics to provide an early warning of impending deterioration. The use of HeRO monitoring has been proven to reduce mortality, length of stay, cost, and even cerebral palsy in the largest randomized controlled trial ever conducted among very low birth weight NICU patients.

The abnormal heart rate characterstics (HRC) that cause HeRO Scores to rise are associated with cytokines. These mediators of the inflammatory response cause changes throughout the body, including the way that the SA node of the heart responds to the autonomic nervous system. HeRO is a real-time, non-invasive window into the inflammatory process that tells clinicians that a patient is deteriorating often before other clinical signs are present. Earlier diagnoses lead to more effective treatment and improved outcomes

The HeRO Whiteboard Episode 3 – Predictive Accuracy for Infection

In this episode of the HeRO Whiteboard, we talk about the predictive accuracy of HeRO for infection. In the evaluation of predictive analytics or any early warning system, it is important to analyze forward looking metrics like positive predictive value, negative predictive value, and risk ratio that accurately capture the decisions a clinician must make in real-time: what is likely to happen to this patient and what actions should I take now? Many clinicians are familiar with sensitivity and specificity, but these metrics look back in time, once the status of the patient is already known.

But most importantly, any of these metrics of model performance are used to estimate the clinical impact of the model on patient outcomes when we don’t have the data. With HeRO, though, we ran the largest RCT in neonatology. So we know the impact of HeRO monitoring on outcomes: reduced mortality, length of stay, cost, and cerebral palsy.

The HeRO Whiteboard Episode 4 – HeRO Randomized Controlled Trial

In this episode, we review the results from a very large clinical trial that evaluated outcomes for infants who were monitored by HeRO versus the control group without HeRO monitoring. This 3,003 patient clinical trial is the largest single randomized controlled trial ever conducted in neonatal medicine.

Patients randomized to HeRO display had reduced all-cause mortality, reduced mortality after infection, reduced length of stay, reduced cost, and reduced rates of severe cerebral palsy.

The HeRO Whiteboard Episode 5 – Neurodevelopment

In today’s episode, we talk about the studies that investigated the neurodevelopmental outcomes of infants who were HeRO monitored during their stay in the NICU.

Elevated HeRO Scores are associated with abnormal EEG findings, abnormal MRI findings, and higher grades of IVH. Extremely Low Birthweight babies in the HeRO RCT who were randomized to HeRO display had reduced mortality at 18-22 months, a trend toward reduced mortality or neurodevelopmental impairment at 18-22 months, and reduced mortality or severe cerebral palsy at 18-22 months.

The HeRO Whiteboard Episode 6 – Testing and Antibiotic Stewardship

In this episode of the HeRO Whiteboard, we review the impact of HeRO monitoring on rates of testing and antibiotics. One study found that patients randomized to HeRO monitoring had no overall increase in antibiotics. Another study separately analyzed those patients that were septic from those that remained healthy. It found septic patients were better targeted with antibiotics, and experienced reduced mortality, while healthy patients had no change in antibiotic usage. Patients that were HeRO monitored experienced more days alive, had non-significant trends toward more days alive and without antibiotics as well as more days alive and without a blood culture, and a significant improvement in days alive and without an unnecessary blood culture. Finally, a recently published abstract demonstrated that HeRO Scores in the time period after a culture was drawn for early onset infection, but before the culture result is available, have a 99% negative predictive value for the culture result; this offers a further opportunity to improve antibiotic stewardship.

The HeRO Whiteboard Episode 7 – Intubation / Extubation

Recent investigations have shown the utility of incorporating HeRO into clinical decision support for extubation readiness and extubation success. In this episode of the HeRO Whiteboard, we explore that literature, and show the CDS tools now available on the HeRO website (www.heroscore.com/extubation).

The HeRO Whiteboard Episode 8 – Product and Installation

In this episode of the HeRO Whiteboard, we discuss the different forms of the HeRO product and the installation for each. HeRO solo and HeRO duet are one- and two-bed stand-alone HeRO monitors that require no IT involvement for installation. HeRO ES is a version that runs within certain Philips monitors equipped with an internal PC, or iPC. HeRO Symphony is the networked implementation, where HeRO Scores are available on central stations, any clinical workstation PC in the hospital, and can even be pushed into the EMR via HL7.

The HeRO Whiteboard Episode 9 – The Case for HeRO

In this final episode of the HeRO Whiteboard, we wrap up with the case for HeRO. In it, we counter the concerns about the system and provide a summary of the overwhelming clinical evidence in support of HeRO monitoring.