The electrocardiogram in preterm infants with intraventricular hemorrhage and apnea

To determine the relationship of electrocardiographic changes to both intraventricular hemorrhage (IVH) and neonatal apnea, continuous electrocardiographic monitoring, serial electrocardiograms, and cranial echoencephalograms were obtained on 41 consecutive preterm neonates with birth weight below 1,250 g. Nineteen patients (46%) were diagnosed as having an IVH within the first postnatal week. Six patients died while still requiring mechanical ventilation. Of the 35 surviving infants, 21 experienced apnea. Though the QRS axis was significantly different in the two groups, in both groups it was within the normal range. Of note, 69% of those surviving neonates with IVH experienced apnea, while 53% of those surviving without IVH had apnea. Unlike adult patients with subarachnoid hemorrhage, there are no characteristic electrocardiographic changes in preterm neonates with IVH. Therefore, the neonatal electrocardiogram could not be used to predict neonatal apnea. Continuous electrocardiographic monitoring was useful in detecting transient arrhythmias and episodes of bradycardia in apneic infants. Infants with IVH appeared to be at higher risk for neonatal apnea than their non-IVH peers. The authors stress the importance of continuous electrocardiographic monitoring in all preterm neonates at risk for IVH.