Study of cardiac arrhythmias and other forms of conduction abnormality in newborn infants.

Southall, D P; Orrell, M J; Talbot, Jo-Ann; Brinton, R J; Vulliamy, David; Johnson, Alan M.; Keeton, Barry R.; Anderson, Robert H.; Shinebourne, E A

doi:10.1136/bmj.2.6087.597

Cited by 42 publications

(15 citation statements)

References 6 publications

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“…In none of these studies [16,23,27,28] was there detailed analysis of variations in cardiac rate or QT i nterval . However, since bradycardia [29] and dysr hythmia secondary to prolongation of the QT interval continue to be proposed as likely [14,19,21,22] though controversial [6, ii, 15, 25] etiologic mechanisms in SIDS, data on the normal rhythm s pectrum are necessary .…”

Section: Discussionmentioning

confidence: 97%

“…In this group he also noted temporal variation in individuals' heart rates, which he described as minimal to wide . Twenty-four-hour monitoring has also been performed by Southall and co-workers [23] in a somewhat older population : 80 clinically normal infants with ages ranging from 9 days to 6 weeks . They noted potentially important dysrhythmias in two subjects ; one had sinoatrial block and one had multiple ventricular extrasystoles .…”

Section: Discussionmentioning

confidence: 98%

“…Data obtained by continuous ECG monitoring in clinically normal populations [1,2,12,16,23] have revealed various rhythms previously considered to be abnormal . Clarke et al [2] studied 86 normal adults between the ages of 16 and 65 years and found that 10 had what were considered disturbances of rhythm of "serious prognostic importance ."…”

Section: Discussionmentioning

confidence: 99%

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The spectrum of cardiac rate and rhythm in normal newborns

et al. 1982

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The distribution and variation of cardiac rate and rhythm in normal neonates has previously received little attention. This has made clinical assessment of dysrhythmia in newborns difficult. We therefore performed continuous 24-hour electrocardiography in 29 normal newborn subjects (age range, 1 to 6 days; mean, 3.5 days). The ECG tapes were then analysed in detail to define the normal range of cardiac rate, conduction intervals, and rhythm during waking and sleeping periods. Maximum sinus rate (awake) ranged from 150 to 222 beats per minute (mean, 192 +/- 16 [SD]), and minimum rate (awake) from 78 to 140 beats per minute (mean, 107 +/- 15). During sleep, the maximum rate ranged from 125 to 210 (mean, 168 +/- 23) and the minimum from 72 to 120 beats per minute (mean, 92 +/- 11). The maximum variation in rate for any individual during the 24-hour period ranged from 73 to 134 beats per minute (mean, 100 +/- 17). Sinus rhythm predominated with mild irregularity occurring episodically in 24 and moderate irregularity in 4 infants. An isolated atrial premature beat was present in 2 subjects, and an atrioventricular (AV) junctional escape rhythm occurred in one other after a sinus pause of 840 msec. Ventricular premature beats or AV conduction abnormalities were not observed. The corrected QT interval (QTc) ranged from 0.298 to 0.514 sec (mean, 0.390 +/- 0.026). The maximum variation in QTc over 24 hours ranged from 0.052 to 0.160 sec (mean, 0.097 +/- 0.028). We conclude that cardiac rhythm and conduction appear more stable in normal newborns than in older normal subjects and that bradycardia, conduction defects, and ventricular ectopy of the type recently reported in young normal adults seem to be more uncommon in the neonatal period.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

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The spectrum of cardiac rate and rhythm in normal newborns

et al. 1982

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“…Another limitation was the lack of a control group. However, some studies have addressed the incidence of arrhythmias in the neonatal population as ranging from 1 to 5% [24,25] . The incidence of lidocaine-associated cardiac adverse events reported in our study is not higher than this background incidence.…”

Section: Discussionmentioning

confidence: 99%

Lidocaine-Associated Cardiac Events in Newborns with Seizures: Incidence, Symptoms and Contributing Factors

Weeke

Schalkwijk²,

Toet³

et al. 2015

Neonatology

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Background: Lidocaine is an effective therapy for neonatal seizures; however, it is not widely used, presumably due to the risk of cardiac events. Objective: To investigate the incidence of cardiac events in full-term and preterm infants receiving lidocaine for seizures. Methods: Full-term (n = 368) and preterm (n = 153) infants, admitted to a level 3 neonatal intensive care unit from 1992 to 2012, who received lidocaine for seizures were retrospectively studied. The causal relation between reported cardiac events and lidocaine administration was evaluated based on expected plasma concentrations, symptoms and relevant interactions during cardiac events. Results: Cardiac events were reported in 11/521 infants (2.1%; 9 full-term, 2 preterm). In 7/11 infants the causal relation was considered plausible, in 3/11 questionable and in 1/11 implausible. The incidence was calculated to be 1.3-1.9% (n = 7-10/521), but was only 0.4% (n = 1/246, p = 0.02) when using reduced-dose regimens. Important risk factors for cardiac events were unstable potassium, (congenital) cardiac dysfunction and concurrent phenytoin use. Conclusions: Lidocaine-associated cardiac events were rare in our cohort, especially since the introduction of new reduced-dose regimens. This indicates that lidocaine is safe to use as an antiepileptic drug in full-term and preterm infants.

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“…On the contrary, after the age of 8 months, the mean value of the spontaneous sinus pause recorded during Holter monitoring stays within 1,000 ms whereas the sinus pause induced during the OCR increases dramatically with age. According to our own findings established from a normal control population and infants referred for ALTE [36,37] and according to data in the literature on sinus rhythm [38][39][40][41][42], we have selected the following criteria in favor of VO: HR less than 80 bpm before age 1 month, HR less than 70 bpm before age 2 months, HR less than 60 bpm before age 1 year, or sinus pauses 11,000 ms, or ¢Fi 1 100, % RF 1 0.55 (i.e. an abrupt and brief deceleration of more than 100 bpm during a 10-second period).…”

Section: Ecg Diagnosismentioning

confidence: 99%

Paroxysmal Vagal Overactivity, Apparent Life-Threatening Event and Sudden Infant Death

Lucet¹,

Bethmann

Denjoy³

2000

Neonatology

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The possibility of reversible cardiac asystoly due to paroxysmal vagal overactivity (VO) has been well studied, first in adults, then in children, and finally in breath-holding spells. Few studies deal with infants and the incidence of VO among preterm, apparent life-threatening event (ALTE) and sudden infant death syndrome (SIDS). In this review, we summarize data acquired during the past 20 years leading to the diagnosis of VO in infants. We describe the clinical aspects of VO in infants and young children such as Holter-ECG and oculocardiac reflex criteria. The familial aspect of VO and its possible link with SIDS (a new risk factor?) are discussed. Finally, whether or not to treat infants with symptomatic VO is discussed.

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Study of cardiac arrhythmias and other forms of conduction abnormality in newborn infants.

Cited by 42 publications

References 6 publications

The spectrum of cardiac rate and rhythm in normal newborns

The spectrum of cardiac rate and rhythm in normal newborns

Lidocaine-Associated Cardiac Events in Newborns with Seizures: Incidence, Symptoms and Contributing Factors

Paroxysmal Vagal Overactivity, Apparent Life-Threatening Event and Sudden Infant Death

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