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Precordial ECG Amplitudes in the Days After Birth: Electrocardiographic Changes During Transition from Fetal to
Sara Osted Hvidemose1, Maria Munk Pærregaard1, Christian Alexander Pihl1
1Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Danmark.
Insights
Electrocardiogram (ECG) analysis in newborns reveals significant changes in R- and S-wave amplitudes during the first month of life, reflecting the transition from fetal to neonatal circulation. These findings establish new reference values for healthy infants.
Area of Science:
- Cardiology
- Neonatal Medicine
- Biomedical Engineering
Background:
- The transition from fetal to neonatal circulation involves significant alterations in right and left ventricular function.
- Electrocardiography (ECG) is a crucial tool for assessing cardiac function in newborns.
- Understanding normal ECG changes in the neonatal period is essential for identifying potential cardiac abnormalities.
Purpose of the Study:
- To describe the electrocardiographic transition from fetal to neonatal circulation.
- To investigate changes in R- and S-wave amplitudes in leads V1 and V6 during the first 4 weeks of life.
- To establish updated reference values for ECG parameters in healthy newborns.
Main Methods:
- Prospective, population-based study (Copenhagen Baby Heart Study) including 14,577 healthy newborns within 28 days of birth.
- Standard 12-lead ECGs were obtained and analyzed using a computerized algorithm.
- Analysis focused on R-wave and S-wave amplitudes in leads V1 and V6.
Main Results:
- Significant decreases observed in R-V1 (1262 to 947 µV) and S-V1 (1240 to 473 µV) amplitudes within 28 days.
- Significant increases observed in R-V6 (825 to 1196 µV) amplitudes, while S-V6 decreased (830 to 634 µV).
- Large interindividual variation in amplitudes noted (up to 20-fold); no significant effect of sex; positive correlation with newborn weight and gestational age for some amplitudes.
Conclusions:
- Systematic ECG analysis in healthy newborns shows significant, quantifiable changes in specific wave amplitudes during the first month of life.
- The large interindividual variation suggests ECG alone may not be a sensitive tool for diagnosing congenital heart disease in this age group.
- The study provides updated, digitalized reference values for neonatal ECG parameters, valuable for clinical and research purposes.
Abstract:
During the first month of life, the relation between right and left ventricular function is markedly altered. We aimed at describing the electrocardiographic transition from fetal to neonatal circulation by investigating changes in R- and S-wave amplitudes in V1 and V6 during the first 4 weeks of life. This study is part of the prospective, population-based Copenhagen Baby Heart Study offering cardiac evaluation to newborns within 28 days from birth. ECGs were obtained and analyzed using a computerized algorithm. A total of 14,577 newborns (52% boys), median age of 11.0 days, were included. All had normal echocardiograms. Within 28 days from birth, the amplitudes in V1 decreased: R-V1 (1262 µV day0; 947 µV day28, p < 0.001) and S-V1 (1240 µV day0; 473 µV day28, p < 0.001). An increase was observed for R-V6 (825 µV day0; 1196 µV day28, p = 0.002), while S-V6 decreased (830 µV day0; 634 µV day28, p = 0.003). For all amplitudes, interindividual variation was large (up to 20 times). The amplitudes were not affected by sex (p > 0.05), but R-V1, R-V6, and S-V6 positively correlated with newborn weight (p < 0.01). R-V1 and S-V6 showed positive correlation with gestational age (p < 0.05). In conclusion, systematic analyses of ECGs from healthy newborns showed significant decreases in R-V1, S-V1, and S-V6 amplitudes, while R-V6 increased. Interindividual variation was large, making ECGs unlikely as a sensitive tool for diagnosing congenital heart diseases. Our data may serve as updated, digitalized reference values in newborns.
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