Prevalence, Clinical Significance and Time-Course of Neonatal ECG Abnormalities associated with Arrhythmias during Infancy: the experience of Brindisi

Background: Some rhythm disturbances may be detected on the surface electrocardiogram even during the neonatal period. Most of them are transitory and benign arrhythmias, others can constitute the first sign of cardiac disease or may become malignant and life-threatening. Furthermore, arrhythmogenic syndromes such as the Long QT syndrome and the Brugada syndrome can cause sudden death in infancy and may also contribute to SIDS (Sudden Infant Death Syndrome). The risk of fatal arrhythmias - which often manifest themselves in infancy, childhood or even at later age - justifies preventive measures. Since diagnosis in symptom-free patients requires electrocardiography, such a non invasive methodology must be available to provide early diagnosis and therapy. The Italian Ministry of Health has funded a prospective study in 50.000 neonates, involving 16 Italian centers, to assess the feasibility of a nationwide neonatal ECG screening. Aim: The purpose of this project was to assess prevalence and clinical significance of neonatal ECG abnormalities. This paper considers the data collected in Brindisi, at the “Perrino” Hospital, with the participation of ISBEM (Euro Mediterranean Scientific Biomedical Institute). Methods: From 2001 to 2006, electrocardiograms were recorded and the demographic data of newborns and of their parents were collected, as well as the clinical history of the newborn babies and of their mothers. All electrocardiographic parameters were measured according to the guidelines for the interpretation of the neonatal ECG. Data of all newborns enlisted in the study were entered into the neonatal ECG database. Newborns with clinically relevant ECG abnormalities were followed-up, according to the guidelines work-up section for clinical management of pathologies related to ECG anomalies. Results: Of the 2619 ECGs recorded, 418 (16%) presented abnormalities. Among the abnormalities 5 (0.2%) had a major clinical significance such as prolonged QT syndrome, Wolff-Parkinson-White syndrome and congenital heart disease. Conclusions: Although life-threatening arrhythmias are rare in infants, they are very serious and must be sought to avoid both short- and long-term morbidity and mortality. The electrocardiographic screening for neonates, as an additional measure of prevention, especially for the early identification of infants at risk of life-threatening arrhythmias, is available and relatively at low cost, and can also help detecting complex cardiac malformations.