ECG challenge: a Kangaroo pitfall

Area of Science:

• Neonatal Medicine
• Cardiology
• Medical Monitoring

Background:

• Neonatal intensive care units (NICUs) commonly use bedside monitoring for preterm infants.
• Kangaroo care, a method of skin-to-skin contact, is beneficial for preterm infants but can introduce monitoring challenges.
• Electrocardiogram (ECG) interpretation in neonates requires careful consideration of potential artifacts.

Purpose of the Study:

• To describe a case of artifactual arrhythmia in a preterm infant.
• To highlight the potential for maternal cardiac signals to interfere with neonatal ECG monitoring during kangaroo care.
• To emphasize the importance of recognizing monitoring pitfalls in neonatal cardiology.

Main Methods:

• Observation of bedside monitoring and single-lead ECG tracing in a 32-week preterm infant.
• Analysis of alternating QRS morphologies on the ECG.
• Intervention involving repositioning the infant and adjusting the respiratory interface.

Main Results:

• Apparent irregular rhythm with alternating QRS morphologies was initially observed.
• Two independent rhythms were detected: the infant's sinus rhythm and a superimposed maternal rhythm.
• Resolution of artifactual complexes and heart rate normalization occurred after repositioning and interface adjustment.

Conclusions:

• Maternal cardiac signals detected by neonatal monitoring electrodes during skin-to-skin contact can mimic neonatal arrhythmia.
• Careful assessment and adjustment of monitoring setup are crucial for accurate neonatal ECG interpretation.
• This case underscores a significant pitfall in neonatal monitoring, emphasizing the need for vigilance.