A Study on Electrocardiographic Changes and Outcome of Severe Dengue in the Pediatric Population

Cardiac involvement in dengue ranges from transient, self-limited changes to life-threatening dysfunction. In children with severe dengue, early identification of electrocardiographic (ECG) abnormalities may inform risk and management. This study evaluated the pattern of ECG changes and their association with outcomes in pediatric severe dengue.

We conducted a prospective observational study over one year in the pediatric wards and PICU of a tertiary care hospital. Children aged 1-18 years meeting WHO 2014 criteria for severe dengue and positive for NS1 and/or immunoglobulin M were enrolled. A 12-lead ECG was performed within 24 h of severe dengue diagnosis. Data were analyzed using Chi-square or Fisher's exact test (significance 0.05).

Eighty children were included (mean age: 9.73 ± 5.08 years; 69% of males). Predominant clinical features were fever (85%), abdominal pain (47.5%), and vomiting (46.3%). Thrombocytopenia occurred in 92.5%, and liver function derangement in 50%. ECG was abnormal in 24/80 (30%): sinus tachycardia 66.7%, ST-T changes 45.8%, sinus bradycardia 37.5%, PR prolongation 29.2%, and other changes (arrhythmias, QRS alterations, and heart block) 20.8%. Overall, 95% were discharged, 3.8% developed MODS, and 1.3% died.

About one-third of children with severe dengue had early ECG abnormalities, most commonly sinus tachycardia and ST-T changes. While ECG abnormalities overall did not predict mortality or MODS, arrhythmias, conduction/QRS abnormalities, and heart block were linked to longer hospitalization, suggesting increased morbidity and recovery time.