# Intelligent Neonatal Sepsis Early Diagnosis System for Very Low Birth Weight Infants
###### Abstract  
Neonatal sepsis is a critical pathology that particularly affects the neonates in intensive care, especially if they are preterm and low birth weight, with an incidence varying between 1 and 40% according to the onset (early or late) of the disease. Prompt diagnostic and therapeutic interventions could reduce the high percentage of mortality that characterises this pathology, especially in the premature and low weight neonates. The HeRO score analyses the heart rate variability and represents the risk of contracting sepsis because of the hospitalization in the neonatal intensive care unit up to 24 h before the clinical signs. However, it has been demonstrated that the HeRO score can produce many false-positive cases, thus leading to the start of unnecessary antibiotic therapy. In this work, the authors propose an optimised artificial neural network model able to diagnose sepsis early based on the HeRO score along with a series of parameters strictly connected to the risk of neonatal sepsis. The proposed methodology shows promising results, outperforming the diagnostic accuracy of the only HeRO score and reducing the number of false positives, thus revealing itself to be a promising tool for supporting the clinicians in the daily clinical practice. neonatal sepsis; HeRO duet; HeRO score; artificial neural network +
Footnote †: journal:For the reason reported above, in this work, we will use the term sepsis to refer to a clinically manifest infection with systemic inflammatory response syndrome (SIRS) even when the result of the culture for pathogens is not yet available. This study focuses on LONS, which is the first cause of death of VLBW neonates who survive the first week of life. This pathology can be subtle or explosive and entails mortality ranging from 10 to 30% depending on the patient's vulnerability and the virulence of the germ [6]. From a clinical point of view, the strategy to combat sepsis includes three main steps, namely prevention, early diagnosis and treatment. Prevention and early diagnosis are clearly preparatory for the treatment and condition its timeliness. Prevention is the most effective measure against sepsis, especially the scrupulous hand hygiene of the clinical operators [7]. Early diagnosis of sepsis would allow timely antibiotic therapy, which is essential to reduce the severity and duration of the disease, as well as lead to more favourable outcomes. In the literature, the effectiveness of the early administration of antibiotics is clearly described; even just an hour can reduce the mortality rate of sepsis [7,8]. Early diagnosis is based on a screening test that is performed with biomarkers, such as reactive C-protein and procalcitonin, which do not have strong specificity and often reveal positivity late, concurrently or even after the clinical onset. Conversely, the search of pathogens' DNA is a costly and not always available method. Finally, blood culture can produce false-negatives and does not have rapid response times. All these methods, therefore, do not satisfy the need to be able to diagnose sepsis early [9]. Hence, more appropriate tests are needed, which should be highly sensitive, predictive, fast to perform and safe for this fragile category of babies. In the scenario just described, the development of the HeRO (Heart Rate Observation) monitor was prompted by the observation that physiological perturbations in the early phase of sepsis are reflected by subtle, complex changes in heart rate characteristics. Decreased heart rate variability and transient repetitive heart rate decelerations occur in neonatal sepsis, often before a patient shows obvious clinical signs.