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QTc interval in infants receiving cisapride
Satbir Chhina1, Ricardo L Peverini, Douglas D Deming
1Doctor's Hospital, Laredo, TX, USA.
Insights
Cisapride treatment in infants caused corrected QT (QTc) interval prolongation in 30% of cases, but most normalized within 14 days. Early QTc monitoring can identify infants at risk.
Area of Science:
- Pediatric Cardiology
- Clinical Pharmacology
Background:
- Cisapride is used to improve gastrointestinal motility in infants.
- The potential for cisapride to affect cardiac repolarization, specifically the corrected QT (QTc) interval, requires careful evaluation in pediatric populations.
Purpose of the Study:
- To investigate the impact of cisapride on the QTc interval in infants over a 14-day treatment period.
- To identify potential predictors of QTc interval prolongation during cisapride therapy.
Main Methods:
- A prospective cohort study involving infants treated with cisapride (0.8 mg/kg/day).
- Electrocardiograms were recorded at baseline and on days 3, 5, 7, and 14 post-initiation of cisapride.
- Analysis focused on changes in QTc interval and the incidence of prolongation.
Main Results:
- Thirty percent (15 of 50) of infants experienced QTc interval prolongation (≥450 msec).
- In most cases (13 of 15), the QTc interval normalized by day 14.
- Infants with a QTc interval ≥2 standard deviations above the mean baseline on day 3 were significantly more likely to develop prolonged QTc intervals (p<0.0001).
Conclusions:
- Cisapride therapy can lead to transient QTc interval prolongation in a significant proportion of infants.
- Early identification of QTc prolongation risk, using measurements from day 3, is possible.
- With vigilant monitoring, cisapride may be safely used to enhance gastrointestinal motility in hospitalized infants without significant cardiac complications.
Objective:
To examine the effect of cisapride on the corrected QT (QTc) interval in infants over a 14-day period.
Study Design:
A prospective cohort study of infants receiving cisapride (0.8 mg/kg per day). Twelve-lead electrocardiograms were obtained before and 3, 5, 7, and 14 days after cisapride initiation.
Results:
Fifty infants completed the study; none had arrhythmias. Fifteen of 50 infants (30%) developed QTc interval > or =450 msec; QTc interval normalized in 13 of 15 infants. Infants with QTc interval on day 3 > or =2 standard deviations above the mean baseline QTc interval (401+40 msec) were more likely to develop prolonged QTc interval (p<0.0001).
Conclusion:
QTc interval prolongation was noted in 30% of infants. Subsequently, the majority of those infants had QTc interval normalization by day 14 of cisapride therapy. QTc interval 3 days following cisapride initiation may identify infants at risk for transient QTc interval prolongation. With appropriate monitoring, hospitalized infants receiving cisapride may have improved gastrointestinal motility without cardiac morbidity.