Normal Heart Rate (10Ns)

This page is part of the 10N-Matrix for a high quality conduct of pediatric anesthesia care.

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Definition

Maintenance of expected heart rate within a normal range of the patient (age dependent)

Importance

Autonomic control of the heart rate in utero is mediated predominantly via the parasympathetic nervous system. Just after birth the sympathetic control begins to appear, although the parasympathetic nervous system continues to dominate in childhood decreasing only in adolescence.

In neonates and infants, the heart rate may have a wide variation that is still within normal limits. The mean heart rate in neonates in the first 24 hours is 120 beats per minute, it increases to a mean of 160 beats per minute at 1 month of age, after which it gradually decreases to 75 beats per min at adolescence (Table 1).

In young children cardiac output is very much depended on heart rate and any heart rate < 100 beats per minute should be explored further and treated if necessary.

In older children, a significant number of arrhythmias and conduction abnormalities are also encountered, with marked fluctuations in heart rate caused by variations in autonomic tone.

Age	Mean heart rate in beats per minute (range)
Premature	120-170
0-3 months	100-150
3-6 months	90-120
6-12 months	80-120
1-3 years	70-110
3-6 years	65-110
6-12 years	60-95
> 12 years	55-85

Table 1. The relationship between age and heart rate

Consequences

Acute deviations from patient specific norms may result in physiologically and clinically relevant impairments of organ and tissue perfusions

Prevention and treatment

Strive to achieve sufficient organ perfusion:

monitor heart rate appropriately
identify and treat underlying causes for bradycardia (hypoxemia, hypotension, drug errors, reflexes)
prepare / administer epinephrine and/ or anticholinergics
perform external cardiac compression in children if acute bradycardia (< 60 bpm) and with signs of poor perfusion occurs

Key references

Richards JM et al. Sequential 22-hour profiles of breathing pattern and heart rate in full-term infants during their first 6 months of life. Pediatrics 1984; 74: 763-77
Hartman ME, Cheifetz IM. Pediatric emrgencies and resuscitation. In: Kliegman RM, Stanton ST, Gerne III, Schor NF, Behrman RE (eds). Nelson Textbook of Pediatrics 20 Ed. Philadelphina Elsevier 2016.