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
Department of Surgery, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Jan Henrik Raynor Becker
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)


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.