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Asystoles during infancy recorded by home memory monitors. Benign events?
R G Meny1, K Currey, J N Scheel
1SIDS Institute, University of Maryland School of Medicine, Baltimore, USA.
Insights
Asystoles, or sinus arrests, are more common in preterm infants but appear benign in the 2.0- to 4.0-second range. Further research is needed to refine guidelines for infant pacemaker implantation.
Area of Science:
- Neonatal cardiology
- Pediatric monitoring
Background:
- Home cardiorespiratory monitors are used for infants at risk.
- Understanding abnormal heart rhythms like asystole and bradycardia is crucial for infant care.
Purpose of the Study:
- To determine the frequency and clinical significance of asystole (sinus arrest ≥ 2.0 seconds) in infants using home cardiorespiratory monitors.
- To assess the incidence of bradycardia in these infants.
- To test if asystoles are more prevalent in preterm infants.
Main Methods:
- A prospective, consecutive sample of 291 memory monitor printouts from 161 infants over 2 months was analyzed.
- Infants were from a university hospital setting.
- Asystoles, bradycardias, and the clinical course of affected infants were the primary outcomes.
Main Results:
- Eight infants (5.0%) experienced 32 episodes of asystole (2.0-4.3 seconds).
- Fifty-three infants (32.9%) had bradycardia alarms without asystole.
- Preterm infants were significantly more likely to have asystoles or bradycardias compared to full-term infants.
Conclusions:
- Asystoles in the 2.0- to 4.0-second range appear benign in infants, particularly preterm infants.
- Long-term recording studies are necessary to redefine asystole criteria for both preterm and full-term infants.
- These findings can inform updated guidelines for pacemaker implantation in infants.
Objectives:
To assess the frequency and clinical significance of asystole (sinus arrest > or = 2.0 seconds) and the incidence of bradycardia in infants prescribed home cardiorespiratory monitors and to test the hypothesis that asystoles are more likely to occur in preterm infants.
Design:
Prospective, consecutive sample of monitor printouts.
Methods:
All 291 printouts from the memory monitors of 161 patients received during a 2-month period were analyzed.
Setting:
University hospital providing primary and referral care.
Main Outcome Measures:
Asystoles and bradycardias; clinical course of patients with asystoles.
Results:
Eight patients (5.0%) had 32 episodes of asystole lasting 2.0 to 4.3 seconds (group 1). Fifty-three patients (32.9%) had true bradycardia alarms but no asystoles (group 2). One hundred patients (62.1%) had neither asystoles nor bradycardias (group 3). Preterm infants constituted 88% of group 1 and 81% of group 2 but only 58% of group 3. Infants were more likely to be full-term in group 3 than in the other 2 groups (chi 2, P = .02). Birth weights were lower in group 1 than in group 3 (P < .05, 1-tailed t test). There were 479 true bradycardias; 72.2% lasted 10 seconds or less, 26.3% were longer than 10 seconds but no more than 20 seconds, and 1.5% were longer than 20 seconds. None of the 8 patients with asystoles required resuscitation for their asystoles; all survived and were free of any life-threatening events after their monitors were discontinued and up until their first birthday.
Conclusions:
Asystoles occur more commonly in preterm infants; those pauses in the 2.0- to 4.0-second range seem to be benign. Studies of long-term recordings are needed to redefine asystole in both normal preterm and fullterm infants. These data would help further refine current guidelines for pacemaker implantation during infancy.