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Published on: June 12, 2020
QTc Interval Reference Values and Their (Non)-Maturational Factors in Neonates and Infants: A Systematic Review
Lisa De Smet1, Nathalie Devolder1, Thomas Salaets2
1Faculty of Medicine, KU Leuven, 3000 Leuven, Belgium.
Insights
QTc interval measurement in neonates is complex due to maturation. This review details QTc trends in infancy, identifying factors like cord clamping and medications affecting these cardiac measurements.
Area of Science:
- Neonatal cardiology
- Pharmacovigilance
- Pediatric electrophysiology
Background:
- QTc interval measurement is crucial for cardiac risk assessment and drug safety.
- Interpreting QTc in neonates is challenging due to maturational changes and unclear reference values.
Purpose of the Study:
- To map QTc value trends during the first year of life in infants.
- To investigate how maturational changes and medication exposure influence neonatal QTc intervals.
Main Methods:
- A structured systematic review (PROSPERO CRD42022302296) was conducted.
- Data on QTc values, infant age, and influencing factors were analyzed.
Main Results:
- Term neonates showed a QTc decrease in the first week, followed by increases until two months, then a decrease until six months.
- Preterm infants exhibited a similar pattern but with longer QTc values.
- Factors influencing QTc included cord clamping, hemodynamics, therapeutic hypothermia, illness, and sleep, but not sex. Certain medications (cisapride, domperidone, doxapram) prolonged QTc.
Conclusions:
- Understanding QTc trends and influencing factors in neonates is vital for accurate screening.
- Further research is needed to refine QTc thresholds and improve pharmacovigilance in this population.
Abstract:
QTc interval measurement is a widely used screening tool to assess the risk of cardiac diseases, arrhythmias, and is a useful biomarker for pharmacovigilance. However, the interpretation of QTc is difficult in neonates due to hemodynamic maturational changes and uncertainties on reference values. To describe trends in QTc values throughout infancy (1 year of life), and to explore the impact of (non)-maturational changes and medicines exposure, a structured systematic review (PROSPERO CRD42022302296) was performed. In term neonates, a decrease was observed over the first week of life, whereafter values increased until two months of age, followed by a progressive decrease until six months. A similar pattern with longer QTc values was observed in preterms. QTc is influenced by cord clamping, hemodynamic changes, therapeutic hypothermia, illnesses and sleep, not by sex. Cisapride, domperidone and doxapram result in QTc prolongation in neonates. Further research in this age category is needed to improve primary screening practices and QTcthresholds, earlier detection of risk factors and precision pharmacovigilance.
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