Electrocardiographic Corrected QT (QTc) Dispersion Value as a Predictor for Estimation of Neonatal Mortality in Pre-Term Neonates

Abstract

Introduction:Electrocardiographic (ECG) corrected QT (QTc) interval and dispersion were used as prognostic variables in adult patients and limited studies showed the relationship between QTc prolongation and dispersion with some clinical situations in newborn babies.Aim:In the present study, we compared the electrocardiographic (ECG) variables such as QTc interval and dispersion of healthy full-term and pre-term neonates with those who suffered from non-cardiac illnesses.Methods:This prospective cohort study involved 127 neonates including four study groups: normal full-term neonates, ill full-term neonates, normal pre-term neonates and ill pre-term neonates. Neonates with fever, apnea, poor feeding, tachypnea, muscle retraction, grunting, reduced neonatal reflexes, positive blood culture or antibiotic therapy > 3 days were considered as ill neonates. QTc interval and dispersion were calculated and compared among the four groups.Results:QTc interval was significantly (p = 0.012) higher in ill pre-term neonates in comparison with normal pre-term ones (418.74± 54.29 ms vs. 386.66± 39.26 ms). QTc dispersion was calculated and showed significantly higher mean values in ill pre-term neonates when compared with normal full-term, ill full-term and normal pre-term ones. QT dispersion and QTc dispersion of dead neonates were significantly (p= 0.0001-0.01) higher than alive ill pre-term neonates at 3, 7 and 28 days after birth.Conclusion:QTc interval and dispersion seem to represent non-invasive, reliable predictors of mortality in pre-term ill neonates, but further investigation is needed to confirm cutoff values for the risk assessment.

QTc Interval Reference Values and Their (Non)-Maturational Factors in Neonates and Infants: A Systematic Review

“…As the QTc interval is a safety marker when medicines are administered in ill preterm and term newborns, it is important to document whether illness itself prolongs the QTc interval. A study by Shabestari et al [ 36 ] provided data on the QTc interval in 127 healthy preterm and term neonates versus ill preterm and term neonates. The types of illnesses are provided in Table S8 (‘covariates’).…”

Qtc Interval Reference Values and Their (Non)-Maturational Factors in Neonates and Infants: A Systematic Review

“…He divided a population of 114 neonates in three cohorts from respectively 31-34 weeks, 34-37 weeks and >37 weeks. Data showed that neonates >37 weeks had a shorter QTc interval on day one to three than preterm (31)(32)(33)(34) neonates and a shorter interval from day two to four than preterm (34)(35)(36)(37) neonates [22]. Thomaidis et al confirmed this limited longer QTc interval in preterms when compared to the fifth day of life in term versus preterm neonates.…”

“…Those 11 cases had significantly higher QTc values than the other ill term neonates. It seems that the QTc interval is associated with mortality in preterm ill neonates, but no cut-off values were determined [36].…”

Discrete Heart Rate Values or Continuous Streams? Representation, Variability, and Meaningful Use of Vital Sign Data

“…While historically collected and recorded in a manual fashion, the advent of bedside monitors now provides for the automated collection of vital sign data, in particular that of heart rate, where measures of stability/variability have repeatedly been to be valuable metrics in assessing patient outcomes 11–13 . Continuous monitoring devices and telemetry systems now link directly to a patient's electronic medical record and can autopopulate this document.…”

“…While historically collected and recorded in a manual fashion, the advent of bedside monitors now provides for the automated collection of vital sign data, in particular that of heart rate, where measures of stability/variability have repeatedly been to be valuable metrics in assessing patient outcomes. [11][12][13] Continuous monitoring devices and telemetry systems now link directly to a patient's electronic medical record and can autopopulate this document. Yet, despite the continuous stream of data made available through these monitors; a patient's chart often reflects only a subset of this information with a series of heart rate snapshots recorded throughout a hospitalization.…”