Oxford University, Department of Primary Health Care, Rosemary Rue Building, Old Road Campus, Headington, Oxford, UK.
Lancet. 2011 Mar 19;377(9770):1011-8. doi: 10.1016/S0140-6736(10)62226-X.
Although heart rate and respiratory rate in children are measured routinely in acute settings, current reference ranges are not based on evidence. We aimed to derive new centile charts for these vital signs and to compare these centiles with existing international ranges.
We searched Medline, Embase, CINAHL, and reference lists for studies that reported heart rate or respiratory rate of healthy children between birth and 18 years of age. We used non-parametric kernel regression to create centile charts for heart rate and respiratory rate in relation to age. We compared existing reference ranges with those derived from our centile charts.
We identified 69 studies with heart rate data for 143,346 children and respiratory rate data for 3881 children. Our centile charts show decline in respiratory rate from birth to early adolescence, with the steepest fall apparent in infants under 2 years of age; decreasing from a median of 44 breaths per min at birth to 26 breaths per min at 2 years. Heart rate shows a small peak at age 1 month. Median heart rate increases from 127 beats per min at birth to a maximum of 145 beats per min at about 1 month, before decreasing to 113 beats per min by 2 years of age. Comparison of our centile charts with existing published reference ranges for heart rate and respiratory rate show striking disagreement, with limits from published ranges frequently exceeding the 99th and 1st centiles, or crossing the median.
Our evidence-based centile charts for children from birth to 18 years should help clinicians to update clinical and resuscitation guidelines.
National Institute for Health Research, Engineering and Physical Sciences Research Council.
尽管心率和呼吸率在儿童的急性病治疗中经常被测量，但目前的参考范围并不是基于证据的。我们旨在为这些生命体征制定新的百分位数图表，并将这些百分位数与现有的国际范围进行比较。
我们在 Medline、Embase、CINAHL 和参考文献中搜索了报告健康儿童（出生至 18 岁）心率或呼吸率的研究。我们使用非参数核回归来创建与年龄相关的心率和呼吸率的百分位数图表。我们将现有的参考范围与从我们的百分位图表中得出的参考范围进行了比较。
我们确定了 69 项研究，其中有 143346 名儿童的心率数据和 3881 名儿童的呼吸率数据。我们的百分位数图表显示，呼吸率从出生到青春期早期呈下降趋势，在 2 岁以下的婴儿中下降最为明显；中位数从出生时的 44 次/分钟降至 2 岁时的 26 次/分钟。心率在 1 个月大时出现一个小高峰。中位数心率从出生时的 127 次/分钟增加到约 1 个月时的最大值 145 次/分钟，然后在 2 岁时降至 113 次/分钟。将我们的百分位图表与现有的心率和呼吸率发表参考范围进行比较，发现差异显著，发表范围的限制经常超过第 99 和第 1 百分位数，或者穿过中位数。
我们基于证据的从出生到 18 岁儿童的百分位图表应该有助于临床医生更新临床和复苏指南。
英国国家卫生研究院、工程和物理科学研究理事会。
