Abnormal heart rate characteristics before clinical diagnosis of necrotizing enterocolitis.
Abnormal heart rate characteristics before clinical diagnosis of necrotizing enterocolitis.
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DOI：
10.1038/jp.2013.63
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发表时间：
2013-11
影响因子：
2.9
通讯作者：
Fairchild, K. D.
中科院分区：
文献类型：
--
作者：
Stone, M. L.;Tatum, P. M.;Weitkamp, J-H;Mukherjee, A. B.;Attridge, J.;McGahren, E. D.;Rodgers, B. M.;lake, D. E.;Moorman, J. R.;Fairchild, K. D.
在早产儿临床病情恶化之前，对坏死性小肠结肠炎（NEC）进行早期诊断和治疗可能会改善预后。一种用于监测变异性降低和反复减速等异常心率特征（HRC）的监测仪被开发出来，用作脓毒症的早期预警系统。由于NEC与脓毒症具有相同的病理生理特征，我们检验了在NEC临床诊断之前出现异常HRC这一假设。
对3个新生儿重症监护病房中参与HRC监测前瞻性随机临床试验的孕周<34周的婴儿中贝尔II - III期NEC病例进行回顾性研究。
在97例有NEC和HRC数据的婴儿中，33例在诊断后一周内接受了手术干预。在诊断前1 - 3天，发展为需要手术治疗的NEC患者与采用内科治疗的NEC患者相比，基线HRC指数更高（2.06 ± 1.98对1.22 ± 1.10，p = 0.009）。在手术治疗的NEC临床诊断前16小时以及内科治疗的NEC临床诊断前6小时，HRC指数显著升高。在临床诊断时，手术治疗的NEC患者与内科治疗的NEC患者相比，HRC指数更高（3.3 ± 2.2对1.9 ± 1.7，p < 0.001）。
异常HRC在NEC临床诊断之前出现，这表明持续的HRC监测可能有助于更早地发现和治疗。
Earlier diagnosis and treatment of necrotizing enterocolitis (NEC) in preterm infants, prior to clinical deterioration, might improve outcomes. A monitor that measures abnormal heart rate characteristics (HRC) of decreased variability and repetitive decelerations was developed as an early warning system for sepsis. Since NEC shares pathophysiologic features with sepsis, we tested the hypothesis that abnormal HRC occur prior to clinical diagnosis of NEC. Retrospective review of Bells stage II to III NEC cases among infants <34 weeks gestation enrolled in a prospective randomized clinical trial of HRC monitoring at 3 neonatal intensive care units. Of 97 infants with NEC and HRC data, 33 underwent surgical intervention within one week of diagnosis. The baseline HRC index from 1 to 3 days before diagnosis was higher in patients who developed surgical versus medical NEC (2.06 ± 1.98 vs. 1.22 ± 1.10, p=0.009). The HRC index increased significantly 16 hours prior to the clinical diagnosis of surgical NEC and 6 hours prior to medical NEC. At the time of clinical diagnosis, the HRC index was higher in patients with surgical versus medical NEC (3.3 ± 2.2 vs 1.9 ± 1.7, p<0.001). Abnormal HRC occur before clinical diagnosis of NEC, suggesting that continuous HRC monitoring may facilitate earlier detection and treatment.
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影响因子：
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