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Developmental Trajectories of Electrocardiographic Parameters in Pediatric Patients
Kazi T Haq1, Kathleen McLean1, Charles I Berul2
1Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC.
Insights
This study establishes detailed electrocardiogram (ECG) norms for infants, revealing significant changes in heart rate (HR) and other parameters during the neonatal period. These ECG developmental trajectories aid in identifying cardiovascular disease deviations in children.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Developmental Physiology
Background:
- Established pediatric electrocardiogram (ECG) parameters lack fine temporal resolution in early life.
- Accurate, age-specific ECG values are crucial for diagnosing and managing pediatric cardiovascular diseases (CVD).
Purpose of the Study:
- To create high-temporal-resolution developmental ECG trajectories for early childhood.
- To assess disease-related deviations in these pediatric ECG parameters.
Main Methods:
- Analyzed 6,967 normal ECGs from neonates, infants, and young children, stratified into 45 age groups.
- Assessed five ECG parameters: heart rate (HR), QRS, PR, QT, and QTc.
- Quantified deviations in ECG trajectories using Z-scores in patients with unrepaired tetralogy of Fallot (TOF) compared to a CVD-free cohort.
Main Results:
- All five ECG parameters showed significant developmental shifts, especially between early and late neonates.
- The neonatal period was identified as the most dynamic phase of electrophysiological maturation.
- Patients with unrepaired TOF displayed altered HR, PR, QRS, and QTc compared to controls, with notable deviations in neonates.
Conclusions:
- High-temporal-resolution ECG trajectories provide essential age-specific norms for early life.
- These detailed ECG norms facilitate the detection of cardiovascular disease-related deviations, particularly in the dynamic neonatal period.
Background:
Normative pediatric electrocardiographic (ECG) parameters have been established in prior studies, but lack fine temporal resolution during early life. Accurate age-specific values are critical for diagnosis, risk stratification, and management of cardiovascular diseases (CVD).
Objective:
To derive high-temporal-resolution developmental trajectories of ECG parameters in early childhood and evaluate disease-related deviations.
Methods:
Five ECG parameters (heart rate (HR), QRS, PR, QT, QTc) were retrospectively analyzed from 6,967 patients at a large pediatric hospital. ECGs were included only if adjudicated as normal by a pediatric cardiologist. Patients were stratified into 45 age groups: neonates (1-35 days, 35 groups), infants (2-6 months, 5 groups), and young children (1-5 years, 5 groups). Sensitivity analysis ranked parameters by age dependence. Z-scores quantified deviations in developmental trajectories between the clinically CVD-free cohort and patients with unrepaired tetralogy of Fallot (TOF, n=305).
Results:
All five ECG parameters demonstrated significant developmental shifts, with marked differences between early (1-8 days) and late neonates (9-35 days). Sensitivity analysis identified the neonatal period as the most dynamic stage of electrophysiological maturation, followed by slower changes in infancy and childhood. Unrepaired TOF patients exhibited deviations from CVD-free children, including altered HR, PR, and QRS in late neonates and QTc outliers (≥ 2 SD), in 32.7% and 24.3% of early and late neonates, respectively.
Conclusion:
High-temporal-resolution ECG trajectories define age-specific norms in early life and enable the detection of disease-related deviations, particularly during the dynamic neonatal period.
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