QTc intervals are not prolonged in former ELBW infants at pre-adolescent age

Abstract

BACKGROUND: Whether preterm birth is associated with cardiac conduction or repolarization abnormalities in later life is still poorly explored, with conflicting data on QTc prolongation in former extreme low birth weight (ELBW, <1000 g) infants. METHODS: Twelve lead electrocardiograms (ECG) at rest, collected in the PREMATurity as predictor of children's Cardiovascularrenal Health (PREMATCH) study in former ELBW cases and term controls during pre-adolescence (8-14 years) were analyzed on corrected QT time (QTc, Bazett) and QT dispersion (QTd). ECG findings were compared between groups (Mann−Whitney), and associations with clinical and biochemical findings were explored (Spearman). In ELBW cases, associations between QTc and perinatal characteristics (at birth, neonatal stay) were explored (Mann−Whitney, Spearman). RESULTS: QTc and QTd were similar between 93 ELBW cases and 87 controls [409 (range 360-465) versus 409 (337-460); 40 (0-100) versus 39 (0-110)] ms. Age, height, weight, or body mass index were not associated with the QTc interval, while female sex (median difference 11.4 ms) and lower potassium (r = −0.26) were associated with longer QTc interval. We could not observe any significant association between QTc interval and perinatal characteristics. CONCLUSIONS: There were no differences in QTc or QTd between ELBW and term controls in ECGs at rest in pre-adolescents.

The QTc-Bazett Interval in Former Very Preterm Infants in Adolescence and Young Adulthood is Not Different from Term-Born Controls

“…Based on the search strategy described, a limited number of papers were retrieved (25 for ‘long QT and preterm’), of which we retained three articles [ 7 – 9 ]. Twenty-two papers were not retained because they were reviews ( n = 2), case reports or clinical observations on congenital long QT (either maternal, fetal, or neonatal; n = 13), drug-related observations during neonatal care (cisapride, 4; erythromycin, 1; serotonin reuptake inhibitors, 1), or related to car seating in former preterm subjects ( n = 1) (ESM Table S1).…”

“…Using the SIGN approach, two papers (Salaets et al [ 9 ] and Gervais et al [ 8 ]) were classified as ‘high quality’. The study by Bassareo et al did not meet these criteria due to uncertainties on the representation of the population (marked difference in sex distribution, with 20/24 females in both cases and controls) and on the blinding procedures, and was hence classified as having ‘low quality’ [ 7 ].…”

“…Reaching out to the corresponding authors resulted in data sharing and access to two of three cohorts (Salaets et al, 93 cases, 87 controls; Gervais et al, 47 cases, 53 controls) for the individual QT c-Bazett and related characteristics [ 7 – 9 ]. Despite repeated attempts, we failed to receive any response from the Bassareo et al study team [ 7 ]; however, based on the figures provided in the paper by Bassareo et al, we were able to extract raw individual data on QT c-Bazett intervals and gestational age in the 24 cases.…”

“…Controls were either term-born friends of the cases or were recruited from an elementary school nearby the research center (Hamont Achel, Belgium). The median age at assessment was 11 (8–14) years [ 9 ]. Bassareo et al recruited former ELBW cases and controls as healthy, term-born subjects, matched for sex, age and body mass index (BMI).…”

“…Relevant for precision pharmacovigilance, Bassareo et al observed a significant difference in mean QT c-Bazett time (417 vs. 369.9 ms) between former ELBW cases and controls [ 7 ]. On the contrary, neither Gervais et al (Canada) nor Salaets et al (Belgium) confirmed these differences in former preterm subjects in young adulthood and late childhood to adolescence, respectively [ 8 , 9 ]. More clarity on the presence or absence of a difference in QT c-Bazett is relevant for precision pharmacovigilance, as certain QTc-prolonging drugs, such as antipsychotics or attention deficit and hyperactivity disorder (ADHD) drugs, are more commonly prescribed in former premature infants [ 10 , 11 ].…”