WIP 44 - Evaluating Heart Rate Characteristic (HeRO Score) Trends for Early Prediction of Necrotizing Enterocolitis in Neonates

Publication Number: WIP 44.7523

Haley McCalpin, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Alistair S. Mukondiwa, Wake Forest Baptist Health - Brenner Children's Hospital, Winston-Salem, NC, United States; Will King, Medical Predictive Science Corporation, Charlottesville, VA, United States; Peter J. Porcelli, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Lacie Fallin, Wake Forest Baptist Health - Brenner Children's Hospital, King, NC, United States; Cherrie Welch, Wake Forest Baptist Health - Brenner Children's Hospital, Winston Salem, NC, United States; Parvesh mohan Garg, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States

Background: Necrotizing enterocolitis (NEC) is the most serious gastrointestinal disease in infants, primarily affecting preterm, low birth weight infants, with a 20-50% mortality rate. Survivors face long-term risks, including intestinal failure and neurodevelopmental impairments. NEC’s etiology is multifactorial with few existing preventative therapies. Diagnosis often occurs after physical changes and radiographic confirmation, highlighting the need for a clinical tool to identify early NEC before clinical deterioration. Infants with sepsis show abnormal heart rates, measured by the HeRO (Heart Rate Observation) score, a bedside tool that reduces sepsis-related mortality by up to 40% [Moorman, J Pediatr 2011]. Since NEC and sepsis are closely associated, the HeRO scores may detect NEC-associated changes earlier than traditional markers, offering a potential tool for early intervention.

Objective: To evaluate the HeRO score as a predictive tool for NEC and its potential to improve neonatal prognosis by indicating developing NEC earlier, to reduce morbidity and mortality rates

Design/Methods: This retrospective cohort study includes 62 neonates diagnosed with NEC at Wake Forest Brenner Children’s Hospital NICU from August 2020 to May 2024. The cohort has a mean birth weight of 1152 g (SD 703.7 g) and median gestational age of 27.4 weeks (range 23–39.5 wks); 59% are male. Racial composition includes 32% White, 45% Black, 2% Asian, and 21% Other. Mortality occurred in 16%.
HeRO score data from 15 days pre- and post-NEC diagnosis are being analyzed alongside clinical variables, including NEC classification, CRP, WBC, clinical presentations, and radiographic findings. The study was approved by the WFU eIRB.

Data Analysis Plan:
Logistic regression will evaluate HeRO score trends preceding NEC diagnosis against traditional markers (CRP, WBC, Hct). Adjusting for confounders (birth weight, gestational age, NEC classification), the model will quantify HeRO’s association with NEC risk, using odds ratios and confidence intervals to determine its predictive capability relative to other markers.