SUMMARY Serial changes in T-wave vector and polarity were assessed in 162 electrocardiograms, 117 from 44 healthy term neonates and 45 from 17 stressed neonates. Records were taken at 5 to 8 hours, 24 to 33 hours, and 71 to 96 hours after birth. Sequential changes in both T-wave amplitude and frontal and horizontal axes were found in both groups. A lag period was noted between healthy and stressed infants when comparing changes in T-wave amplitude, with greater flattening of T-waves for longer periods of time after birth in the stressed group. The normal changes in T-wave axis over time in the horizontal and frontal planes showed a similar lag in the stressed group. Alterations of T-wave amplitude and axis alone may be markers of myocardial ischaemia in neonates but are only reliable signs after the first 24 hours of life.

Although rare, a congenital direct fistula connection between the proximal right pulmonary artery and the left atrium can present as cyanosis in the newborn. We report the first case in which catheter-based coil closure of such a fistula in a neonate resulted in rapid clinical improvement, obviating the need for surgical repair.

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The American College of Cardiology Adult Congenital and Pediatric Cardiology (ACPC) Section had attempted to create quality metrics (QM) for ambulatory pediatric practice, but limited evidence made the process difficult. The ACPC sought to develop QMs for ambulatory pediatric cardiology practice. Five areas of interest were identified, and QMs were developed in a 2-step review process. In the first step, an expert panel, using the modified RAND-UCLA methodology, rated each QM for feasibility and validity. The second step sought input from ACPC Section members; final approval was by a vote of the ACPC Council. Work groups proposed a total of 44 QMs. Thirty-one metrics passed the RAND process and, after the open comment period, the ACPC council approved 18 metrics. The project resulted in successful development of QMs in ambulatory pediatric cardiology for a range of ambulatory domains.

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