TABLE.

What to Do When the HeRO (Heart Rate Observation) Score Is Increasing

Assess the infant and discuss with the clinical care team. How is the infant looking and acting compared to baseline? (Also ask the mother, whose intuition can be valuable.) Are there any concerning physical examination findings, vital signs, or recent abnormal laboratory values suggestive of infection? Consider whether to wait and watch closely, if the score is not very high and the infant looks well. Sometimes a rise in HeRO score does not indicate infection, and the score falls without antibiotics. Of note, however, sometimes the HeRO score rises and falls several times before diagnosis of sepsis, possibly as a result of the immune system containing an infection. send tests (cultures, white blood cell count with differential, C-reactive protein, others) but hold off on antibiotics unless the clinical course or test results are concerning for infection. start antibiotics if the baby has significant clinical signs or a large (>1–2 point) rise in HeRO score without another explanation besides infection. Continue close observation. A continued rise in the HeRO score after starting antibiotics could indicate ongoing illness or inadequately treated infection. Vigilance is key to improving outcomes in neonatal intensive care unit patients, and nurses, as the frontline caregivers, can make a difference by alerting other members of the clinical care team about changes in an infant’s clinical status, including the HeRO score.