Amer J Perinatol 2018; 35(08): 774-778
DOI: 10.1055/s-0037-1615805
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Predictive Value of a Persistent Tachycardia to Indicate Impending Perforation in Necrotizing Enterocolitis

Francisca van der Schyff
1  Department of Surgery, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
,
Jan Henrik Raynor Becker
2  Department of Surgery, Sefako Makgatho Health Sciences University, Pretoria, South Africa
› Author Affiliations
Further Information

Publication History

27 June 2017

15 November 2017

Publication Date:
03 January 2018 (eFirst)

Abstract

Introduction Necrotizing enterocolitis (NEC) is a devastating disease of infancy. Full-thickness bowel wall necrosis may lead to perforation, peritonitis, and death. Timeous clinical diagnosis of impending perforation is imperative.

Objective The objective of this study was to determine whether a persistent tachycardia in an infant with proven NEC is indicative of full-thickness bowel wall necrosis and therefore impending perforation.

Study Design This study was conducted at the University of Pretoria academic hospitals. Forty-five neonates with proven NEC were divided into a surgical group (32 progressed to full-thickness bowel necrosis) and a nonsurgical group (13 resolved on conservative treatment). Differences in the pulse rate between the groups were analyzed.

Results The 24-hour leading average pulse rate data for the surgical group were analyzed over a period of 10 days leading up to surgery and compared with the nonsurgical group. A clear upward trend of the mean pulse rate was observed in the surgical group, 48 hours prior to surgery. This was statistically significant (p < 0.05).

Conclusion This study demonstrated that a persistent tachycardia in a neonate with NEC is a predictor of progression to full-thickness bowel wall necrosis. Pulse rate is therefore an important clinical tool when deciding on operative management in NEC.