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DOI: 10.1055/s-0037-1615805
Predictive Value of a Persistent Tachycardia to Indicate Impending Perforation in Necrotizing Enterocolitis
Publikationsverlauf
27. Juni 2017
15. November 2017
Publikationsdatum:
03. Januar 2018 (online)
![](https://www.thieme-connect.de/media/ajp/201808/lookinside/thumbnails/10-1055-s-0037-1615805_170331-1.jpg)
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.
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References
- 1 Berman L, Moss RL. Necrotizing enterocolitis: an update. Semin Fetal Neonatal Med 2011; 16 (03) 145-150
- 2 Parikh M, Samujh R, Kanojia RP, Rao KL. Decision-making in surgical neonatal necrotizing enterocolitis. J Indian Assoc Pediatr Surg 2009; 14 (03) 102-107
- 3 Henry MC, Moss RL. Current issues in the management of necrotizing enterocolitis. Semin Perinatol 2004; 28 (03) 221-233
- 4 Salluh JI, Soares M. ICU severity of illness scores: APACHE, SAPS and MPM. Curr Opin Crit Care 2014; 20 (05) 557-565
- 5 Vincent JL, Moreno R. Clinical review: scoring systems in the critically ill. Crit Care 2010; 14 (02) 207
- 6 Bohnhorst B. Usefulness of abdominal ultrasound in diagnosing necrotising enterocolitis. Arch Dis Child Fetal Neonatal Ed 2013; 98 (05) F445-F450
- 7 Gephart SM, McGrath JM, Effken JA, Halpern MD. Necrotizing enterocolitis risk: state of the science. Adv Neonatal Care 2012; 12 (02) 77-87 , quiz 88–89
- 8 Singh M, Owen A, Gull S, Morabito A, Bianchi A. Surgery for intestinal perforation in preterm neonates: anastomosis vs stoma. J Pediatr Surg 2006; 41 (04) 725-729
- 9 Wu SF, Caplan M, Lin HC. Necrotizing enterocolitis: old problem with new hope. Pediatr Neonatol 2012; 53 (03) 158-163
- 10 Watkins DJ, Besner GE. The role of the intestinal microcirculation in necrotizing enterocolitis. Semin Pediatr Surg 2013; 22 (02) 83-87
- 11 Rangel S, Moss R. Necrotizing enterocolitis. In: Oldham K. , ed. Principles and Practice of Paediatric Surgery. Philadelphia: Lippincott Williams & Wilkins; 2005: 1251
- 12 Tepas III JJ, Sharma R, Leaphart CL, Celso BG, Pieper P, Esquivia-Lee V. Timing of surgical intervention in necrotizing enterocolitis can be determined by trajectory of metabolic derangement. J Pediatr Surg 2010; 45 (02) 310-313
- 13 Boet A, Jourdain G, Demontoux S, De Luca D. Stroke volume and cardiac output evaluation by electrical cardiometry: accuracy and reference nomograms in hemodynamically stable preterm neonates. J Perinatol 2016; 36 (09) 748-752
- 14 Bell MJ, Ternberg JL, Feigin RD. , et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (01) 1-7
- 15 Fox TP, Godavitarne C. What really causes necrotizing enterocolitis?. ISRN Gastroenterology 2012; (2012). DOI: 10.5402/2012/628317.