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.
Keywords
necrotizing enterocolitis - tachycardia - perforation - neonates
