Related Experiment Video
Updated: Mar 27, 2026
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Evaluation and management of bradycardia in neonates and children
Alban-Elouen Baruteau1,2,3,4, James C Perry5, Shubhayan Sanatani6
1Morgan Stanley Children's Hospital, Division of Pediatric Cardiology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA. alban.baruteau@gmail.com.
Insights
Pediatric bradycardia, a heart rate below normal for age, requires early diagnosis and management to prevent sudden death. Its causes range from genetic variants to congenital heart disease, impacting prognosis and intervention decisions.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Genetics
Background:
- Pediatric bradycardia is defined as a heart rate below the age-specific normal range.
- It commonly presents as sinus bradycardia, junctional bradycardia, or atrioventricular block.
- Normal electrocardiogram features vary with age in infants and children, differing from adults.
Purpose of the Study:
- To critically assess current practices for evaluating and managing bradycardia in neonates and children.
- To highlight the importance of early diagnosis and appropriate management to prevent adverse outcomes.
- To review the etiologies and genetic underpinnings of pediatric bradycardia.
Main Methods:
- Literature review of current practices in pediatric bradycardia evaluation and management.
- Analysis of age-related electrocardiogram variations in pediatric populations.
- Assessment of genetic variants associated with inherited bradycardia.
Main Results:
- Bradycardia in children can stem from diverse etiologies, including genetic variants and congenital heart disease.
- Intervention for bradycardia is indicated when associated with symptoms, heart failure risk, or pause-dependent tachyarrhythmias.
- Management and prognosis are contingent on the underlying cause.
Conclusions:
- Early diagnosis and tailored management are crucial for improving outcomes in pediatric bradycardia.
- Understanding age-related physiological differences is key to accurate diagnosis.
- Appropriate intervention can prevent sudden death and other serious complications.
Abstract:
Heart rate is commonly used in pediatric early warning scores. Age-related changes in the anatomy and physiology of infants and children produce normal ranges for electrocardiogram features that differ from adults and vary with age. Bradycardia is defined as a heart rate below the lowest normal value for age. Pediatric bradycardia most commonly manifests as sinus bradycardia, junctional bradycardia, or atrioventricular block. As a result of several different etiologies, it may occur in an entirely structurally normal heart or in association with concomitant congenital heart disease. Genetic variants in multiple genes have been described to date in the pathogenesis of inherited sinus node dysfunction or progressive cardiac conduction disorders. Management and eventual prognosis of bradycardia in the young are entirely dependent upon the underlying cause. Reasons to intervene for bradycardia are the association of related symptoms and/or the downstream risk of heart failure or pause-dependent tachyarrhythmia. The simplest aspect of severe bradycardia management is reflected in the Pediatric and Advanced Life Support (PALS) guidelines.
Conclusion:
Early diagnosis and appropriate management are critical in many cases in order to prevent sudden death, and this review critically assesses our current practice for evaluation and management of bradycardia in neonates and children.
What Is Known:
Bradycardia is defined as a heart rate below the lowest normal value for age. Age related changes in the anatomy and physiology of infants and children produce normal ranges for electrocardiogram features that differ from adults and vary with age. Pediatric bradycardia most commonly manifests as sinus bradycardia, junctional bradycardia, or atrioventricular block.
What Is New:
Management and eventual prognosis of bradycardia in the young are entirely dependent upon the underlying cause. Bradycardia may occur in a structurally normal heart or in association with congenital heart disease. Genetic variants in multiple genes have been described. Reasons to intervene for bradycardia are the association of related symptoms and/or the downstream risk of heart failure or pause-dependent tachyarrhythmia. Early diagnosis and appropriate management are critical in order to prevent sudden death.
Related Concept Videos
01:14Decreased pulse rate
There are specific risk factors that can elevate the likelihood of developing bradycardia. Advanced age is a significant factor, with...
01:18Dysrhythmias IV: Characteristics of Bradyarrhythmias
01:25Dysrhythmias VII: Nursing Management of Dysrhythmias
01:25Dysrhythmias VI: Management of Dysrhythmias
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:30Pulse rhythm
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...