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Serial electrocardiographic changes in healthy and stressed neonates
Insights
Serial electrocardiogram (ECG) changes in T-wave amplitude and axis reveal distinct patterns in healthy versus stressed neonates. Stressed infants exhibit a lag in T-wave normalization, suggesting potential myocardial ischemia markers after 24 hours.
Area of Science:
- Neonatal cardiology
- Pediatric electrocardiography
- Myocardial ischemia assessment
Background:
- The electrocardiogram (ECG) is crucial for assessing neonatal cardiac health.
- T-wave characteristics on ECG can indicate myocardial function and stress.
- Understanding normal T-wave evolution in neonates is essential for identifying pathology.
Purpose of the Study:
- To analyze serial changes in T-wave vector and polarity in healthy and stressed neonates.
- To identify potential ECG markers for neonatal myocardial ischemia.
- To determine the reliability of T-wave alterations as indicators of ischemia over time.
Main Methods:
- Collected 162 electrocardiograms from 44 healthy and 17 stressed term neonates.
- Recorded ECGs at three time points: 5-8 hours, 24-33 hours, and 71-96 hours post-birth.
- Assessed sequential changes in T-wave amplitude, frontal, and horizontal axes.
Main Results:
- Both healthy and stressed neonates showed sequential changes in T-wave amplitude and axes.
- Stressed neonates exhibited a lag in T-wave amplitude normalization, with prolonged T-wave flattening.
- A similar lag was observed in the stressed group regarding normal T-wave axis progression.
Conclusions:
- Alterations in T-wave amplitude and axis in neonates may indicate myocardial ischemia.
- These T-wave changes are reliable indicators of neonatal myocardial ischemia only after the initial 24 hours of life.
- Serial ECG monitoring is valuable for detecting subtle cardiac changes in stressed newborns.
Abstract:
Serial changes in T-wave vector and polarity were assessed in 162 electrocardiograms, 117 from 44 healthy term neonates and 45 from 17 stressed neonates. Records were taken at 5 to 8 hours, 24 to 33 hours, and 71 to 96 hours after birth. Sequential changes in both T-wave amplitude and frontal and horizontal axes were found in both groups. A lag period was noted between healthy and stressed infants when comparing changes in T-wave amplitude, with greater flattening of T-waves for longer periods of time after birth in the stressed group. The normal changes in T-wave axis over time in the horizontal and frontal planes showed a similar lag in the stressed group. Alterations of T-wave amplitude and axis alone may be markers of myocardial ischaemia in neonates but are only reliable signs after the first 24 hours of life.