The Evolution of the Neonatal QRS Axis during the First Four Weeks of Life

Neonatology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Maria Munk Pærregaard ◽  
Jesper Kock ◽  
Christian Pihl ◽  
Adrian Pietersen ◽  
Kasper Karmark Iversen ◽  
...  
Keyword(s):  
Heart Disease ◽  
General Population ◽  
Early Diagnosis ◽  
Population Study ◽  
Reference Values ◽  
Gestational Age ◽  
General Population Study ◽  
Heart Study ◽  
Cardiac Evaluation ◽  
Ventricular Depolarization

Background: The QRS axis represents the sum and orientation of the ventricular depolarization. Accurate interpretation of abnormalities in the QRS axis may facilitate early diagnosis of heart disease in newborns. We aimed at describing the evolution of the QRS axis during the first 4 weeks of life and provide reference values from healthy newborns. Methods: The Copenhagen Baby Heart Study is a prospective general population study that offered cardiac evaluation during the first month of life to all newborns delivered in the Copenhagen area. Results: Electrocardiograms from 12,317 newborns (52% boys; mean age 12 days) with normal echocardiograms were included. The median QRS axis was 119° at the ages 0–7 days and shifted leftward to 102° at the ages 22–28 days (p < 0.001). We found that girls had a significantly less pronounced right-shifted axis than boys (p < 0.001) and that increasing gestational age (GA) was associated with a more pronounced right-shifted axis (p < 0.05). Infant size did not affect the axis (p > 0.05). Only 0.5% had an axis within the interval 0 to −90° and 1.1% in the interval +240 to +30°. Conclusions: The QRS axis showed a gradual leftward-shift during the first 4 weeks of life and was affected by sex and GA but unaffected by infant size. Less than 1% of the newborns had a QRS axis between 0 and −90°. This study represents updated reference values, which may facilitate the clinical handling of newborns.

Defining the normal QT interval in newborns: the natural history and reference values for the first 4 weeks of life

EP Europace ◽  
2020 ◽  
Author(s):  
Maria Munk Pærregaard ◽  
Sara Osted Hvidemose ◽  
Christian Pihl ◽  
Anne-Sophie Sillesen ◽  
Solmaz Bagheri Parvin ◽  
...  
Keyword(s):  
General Population ◽  
Natural History ◽  
Reference Values ◽  
Qt Interval ◽  
Population Sample ◽  
General Population Study ◽  
Qt Intervals ◽  
Heart Study ◽  
Cardiac Evaluation ◽  
History Of

Abstract Aims Evaluation of the neonatal QT interval is important to diagnose arrhythmia syndromes and evaluate side effects of drugs. We aimed at describing the natural history of the QT interval duration during the first 4 weeks of life and to provide reference values from a large general population sample. Methods and results The Copenhagen Baby Heart Study is a prospective general population study that offered cardiac evaluation of newborns. Eight-lead electrocardiograms were obtained and analysed with a computerized algorithm with manual validation. We included 14 164 newborns (52% boys), aged 0–28 days, with normal echocardiograms. The median values (ms, 2–98%ile) for the corrected intervals QTc (Bazett), QTc (Hodges), QTc (Fridericia), and QTc (Framingham) were 419 (373–474), 419 (373–472), 364 (320–414), and 363 (327–405). During the 4 weeks, we observed a small decrease of QTcFramingham, and an increase of QTcHodges (both P &lt; 0.01), while QTcBazett and QTcFridericia did not change (P &gt; 0.05). Applying published QT interval cut-off values resulted in 5–25% of the newborns having QT prolongation. Uncorrected QT intervals decreased linearly with increasing heart rate (HR). Sex and infant size did not affect the QT interval and the gestational age (GA) only showed an effect when comparing the extreme low- vs. high GA groups (≤34 vs. ≥42 weeks, P = 0.021). Conclusion During the 4 weeks QTcFramingham and QTcHodges showed minor changes, whereas QTcBazett and QTcFridericia were stable. The QT interval was unaffected by sex and infant size and GA only showed an effect in very premature newborns. Reference values for HR-specific uncorrected QT intervals may facilitate a more accurate diagnosis of newborns with abnormal QT intervals.

Gestational Age and Neonatal Electrocardiograms

PEDIATRICS ◽  
2021 ◽  
Author(s):  
Joachim Hartmann ◽  
Maria Munk Pærregaard ◽  
Jakob Norsk ◽  
Adrian Pietersen ◽  
Kasper Karmark Iversen ◽  
...  
Keyword(s):  
Reference Values ◽  
Gestational Age ◽  
Cardiac Conduction ◽  
Specific Reference ◽  
General Population Study ◽  
Heart Study ◽  
Cardiac Evaluation ◽  
Almost All ◽  
Electrocardiogram Ecg ◽  
The Impact

OBJECTIVES Interpretation of the neonatal electrocardiogram (ECG) is challenging due to the profound changes of the cardiovascular system in this period. We aimed to investigate the impact of gestational age (GA) on the neonatal ECG and create GA-specific reference values. METHODS The Copenhagen Baby Heart Study is a prospective general population study that offered cardiac evaluation of neonates. ECGs and echocardiograms were obtained and systematically analyzed. GA, weight, height, and other baseline variables were registered. RESULTS We included 16 462 neonates (52% boys) with normal echocardiograms. The median postnatal age was 11 days (range 0 to 30), and the median GA was 281 days (range 238 to 301). Analyzing the ECG parameters as a function of GA, we found an effect of GA on almost all investigated ECG parameters. The largest percentual effect of GA was on heart rate (HR; 147 vs 139 beats per minute), the QRS axis (103° vs 116°), and maximum R-wave amplitude in V1 (R-V1; 0.97 vs 1.19 mV) for GA ≤35 vs ≥42 weeks, respectively. Boys had longer PR and QRS intervals and a more right-shifted QRS axis within multiple GA intervals (all P &lt; .01). The effect of GA generally persisted after multifactorial adjustment. CONCLUSIONS GA was associated with significant differences in multiple neonatal ECG parameters. The association generally persisted after multifactorial adjustment, indicating a direct effect of GA on the developing neonatal cardiac conduction system. For HR, the QRS axis, and R-V1, the use of GA-specific reference values may optimize clinical handling of neonates.

scholarly journals Low HDL Cholesterol and High Risk of Autoimmune Disease: Two Population-Based Cohort Studies Including 117341 Individuals

2019 ◽  
Vol 65 (5) ◽  
pp. 644-652 ◽  
Author(s):  
Christian M Madsen ◽  
Anette Varbo ◽  
Børge G Nordestgaard
Keyword(s):  
High Risk ◽  
Autoimmune Disease ◽  
General Population ◽  
Population Study ◽  
Hdl Cholesterol ◽  
Apolipoprotein A1 ◽  
General Population Study ◽  
Heart Study ◽  
Low Hdl ◽  
Copenhagen City Heart Study

Abstract BACKGROUND HDL is quantitatively the most important lipoprotein in most species and mechanistic evidence points toward a role for HDL in normal immune function. We tested the hypothesis that concentrations of HDL cholesterol are associated with risk of autoimmune disease. METHODS From 2 studies of the general population—the Copenhagen General Population Study and the Copenhagen City Heart study—we included 107954 and 9387 individuals with baseline measurements of HDL cholesterol. These were followed with the national Danish Patient Registry from baseline in 2003–2015 or 1991–1994 through 2017, during which time 4078 and 1101 individuals developed autoimmune disease in the 2 studies. RESULTS In the Copenhagen General Population Study, compared to individuals with HDL cholesterol ≥2.0 mmol/L (77 mg/dL), the multifactorially adjusted hazard ratios for any autoimmune disease were 1.06 (95% CI, 0.94–1.19) for individuals with HDL cholesterol of 1.5–1.99 mmol/L (58–77 mg/dL), 1.18 (95% CI, 1.04–1.35) for individuals with HDL cholesterol of 1.0–1.49 mmol/L (39–58 mg/dL), and 1.84 (95% CI, 1.52–2.22) for individuals with HDL cholesterol &lt;1.0 mmol/L (39 mg/dL) (P for trend &lt;0.001). These results were similar when excluding events within 5 years of baseline, in women and men separately, for events at baseline, irrespective of low-grade inflammation or triglyceride concentrations, for the apolipoprotein A1 part of HDL, and for more restrictive end point definitions. Finally, the Copenhagen City Heart Study provided independent confirmation. CONCLUSIONS Low HDL cholesterol level is associated with high risk of autoimmune disease in individuals from the general population. Our observational findings cannot determine causality.

scholarly journals Low high-density lipoprotein and increased risk of several cancers: 2 population-based cohort studies including 116,728 individuals

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Kasper Mønsted Pedersen ◽  
Yunus Çolak ◽  
Stig Egil Bojesen ◽  
Børge Grønne Nordestgaard
Keyword(s):  
General Population ◽  
Population Study ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Apolipoprotein A1 ◽  
General Population Study ◽  
Heart Study ◽  
Increased Risk ◽  
Low Hdl ◽  
Copenhagen City Heart Study

Abstract Background Increasing evidence suggests that high-density lipoprotein (HDL) may play a role in cancer development. We tested the hypothesis that low HDL levels are associated with increased risk of cancer. Methods Individuals from two population-based cohorts, the Copenhagen General Population Study (2003–2015, N = 107 341), and the Copenhagen City Heart Study (1991–1994, N = 9387) were followed prospectively until end of 2016 to assess low plasma HDL cholesterol and apolipoprotein A1 as risk factors for cancer using Cox proportional hazard regression. Results During up to 25 years follow-up, we observed 8748 cancers in the Copenhagen General Population Study and 2164 in the Copenhagen City Heart Study. In the Copenhagen General Population Study and compared to individuals with HDL cholesterol ≥ 2.0 mmol/L (≥ 77 mg/dL), multivariable adjusted hazard ratios (HRs) for any cancer were 1.13 (95% confidence interval 1.04–1.22) for individuals with HDL cholesterol of 1.5–1.99 mmol/L (58–77 mg/dL), 1.18 (1.08–1.30) for HDL cholesterol of 1.0–1.49 mmol/L (39–58 mg/dL), and 1.29 (1.12–1.48) for individuals with HDL cholesterol < 1.0 mmol/L (< 39 mg/dL). Correspondingly, compared to individuals with apolipoprotein A1 ≥ 190 mg/dL, HRs for any cancer were 1.06 (0.96–1.17) for individuals with apolipoprotein A1 of 160–189 mg/dL, 1.18 (1.07–1.30) for apolipoprotein A1 of 130–159 mg/dL, and 1.28 (1.13–1.46) for individuals with apolipoprotein A1 < 130 mg/dL. Among 27 cancer types, low HDL cholesterol and/or apolipoprotein A1 were associated with increased risk of multiple myeloma, myeloproliferative neoplasm, non-Hodgkin lymphoma, breast cancer, lung cancer, and nervous system cancer. Results were overall similar in women and men separately, and in the Copenhagen City Heart Study. Conclusions Low HDL levels were associated with increased risk of several cancers. Increased risk was most pronounced for hematological and nervous system cancer, and to a minor extent for breast and respiratory cancer.

scholarly journals Elevated levels of oxidized nucleosides in individuals with the JAK2V617F mutation from a general population study

Redox Biology ◽  
2021 ◽  
Vol 41 ◽  
pp. 101895
Author(s):  
Anders L. Sørensen ◽  
Hans C. Hasselbalch ◽  
Mads Emil Bjørn ◽  
Claus H. Nielsen ◽  
Sabrina Cordua ◽  
...  
Keyword(s):  
General Population ◽  
Population Study ◽  
Jak2v617f Mutation ◽  
General Population Study

Childhood negative experiences and subclinical psychosis in adolescence: a longitudinal general population study

2007 ◽  
Vol 1 (2) ◽  
pp. 201-207 ◽  
Author(s):  
Ellen De Loore ◽  
Marjan Drukker ◽  
Nicole Gunther ◽  
Frans Feron ◽  
Dirk Deboutte ◽  
...  
Keyword(s):  
General Population ◽  
Population Study ◽  
General Population Study ◽  
Negative Experiences ◽  
Subclinical Psychosis

scholarly journals Association of Blood Eosinophil and Blood Neutrophil Counts with Asthma Exacerbations in the Copenhagen General Population Study

2017 ◽  
Vol 63 (4) ◽  
pp. 823-832 ◽  
Author(s):  
Signe Vedel-Krogh ◽  
Sune Fallgaard Nielsen ◽  
Peter Lange ◽  
Jørgen Vestbo ◽  
Børge Grønne Nordestgaard
Keyword(s):  
General Population ◽  
Disease Severity ◽  
Population Study ◽  
Blood Eosinophil ◽  
Blood Neutrophil ◽  
General Population Study ◽  
Asthma Exacerbations ◽  
Increased Risk ◽  
Blood Neutrophils ◽  
Eosinophil Counts

Abstract BACKGROUND Blood eosinophil count is a marker of eosinophilic airway inflammation and disease severity in asthma. However, blood neutrophil count might also be associated with disease severity. We tested the hypothesis that high blood eosinophil and neutrophil counts are both associated with the risk of asthma exacerbations among individuals with asthma from the general population. METHODS From the Copenhagen General Population Study with 81351 participants, we included 4838 with self-reported asthma. We recorded baseline blood eosinophil and neutrophil counts, and asthma exacerbations during follow-up in 2003–2011, defined as moderate (short-course treatment of prednisolone) or severe (hospitalization). RESULTS The multivariable-adjusted incidence rate ratios (IRRs) were 1.28 (95% CI, 1.06–1.55) for moderate exacerbations and 1.55 (1.20–2.00) for severe exacerbations for individuals with blood eosinophil counts &gt;0.29 × 109/L (highest tertile) vs individuals with blood eosinophil counts &lt;0.18 × 109/L (lowest tertile). For blood neutrophils, the multivariable-adjusted IRRs were 2.14 (1.74–2.63) for moderate exacerbations and 1.18 (0.89–1.55) for severe exacerbations for individuals with blood neutrophil counts &gt;4.85 × 109/L (highest tertile) vs individuals with blood neutrophil counts &lt;3.77 × 109/L (lowest tertile). Blood eosinophil and neutrophil counts interacted on moderate exacerbations (P = 3 × 10−4), but not on severe exacerbations. CONCLUSIONS High blood eosinophil counts are associated with an increased risk of both moderate and severe asthma exacerbations, while high blood neutrophil counts are associated with an increased risk of moderate, but not severe exacerbations.

scholarly journals From Epidemiology to Daily Life: Linking Daily Life Stress Reactivity to Persistence of Psychotic Experiences in a Longitudinal General Population Study

PLoS ONE ◽  
2013 ◽  
Vol 8 (4) ◽  
pp. e62688 ◽  
Author(s):  
Dina Collip ◽  
Johanna T. W. Wigman ◽  
Inez Myin-Germeys ◽  
Nele Jacobs ◽  
Catherine Derom ◽  
...  
Keyword(s):  
General Population ◽  
Population Study ◽  
Life Stress ◽  
Stress Reactivity ◽  
Daily Life ◽  
Psychotic Experiences ◽  
General Population Study

Increased Risk for Other Cancers in Addition to Breast Cancer for CHEK2*1100delC Heterozygotes Estimated From the Copenhagen General Population Study

2016 ◽  
Vol 34 (11) ◽  
pp. 1208-1216 ◽  
Author(s):  
Charlotte Näslund-Koch ◽  
Børge G. Nordestgaard ◽  
Stig E. Bojesen
Keyword(s):  
Breast Cancer ◽  
General Population ◽  
Population Study ◽  
Cell Cycle Checkpoint ◽  
Loss Of Function ◽  
General Population Study ◽  
Chek2 1100Delc ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Age And Sex

Purpose CHEK2 is a cell cycle checkpoint regulator, and the CHEK2*1100delC germline mutation leads to loss of function and increased breast cancer risk. It seems plausible that this mutation could also predispose to other cancers. Therefore, we tested the hypothesis that CHEK2*1100delC heterozygosity is associated with increased risk for other cancers in addition to breast cancer in the general population. Patients and Methods We examined 86,975 individuals from the Copenhagen General Population Study, recruited from 2003 through 2010. The participants completed a questionnaire on health and lifestyle, were examined physically, had blood drawn for DNA extraction, were tested for presence of CHEK2*1100delC using Taqman assays and sequencing, and were linked over 1943 through 2011 to the Danish Cancer Registry. Incidences and risks of individual cancer types, including breast cancer, were calculated using Kaplan-Meier estimates, Fine and Gray competing-risks regressions, and stratified analyses with interaction tests. Results Among 86,975 individuals, 670 (0.8%) were CHEK2*1100delC heterozygous, 2,442 developed breast cancer, and 6,635 developed other cancers. The age- and sex-adjusted hazard ratio for CHEK2*1100delC heterozygotes compared with noncarriers was 2.08 (95% CI, 1.51 to 2.85) for breast cancer and 1.45 (95% CI, 1.15 to 1.82) for other cancers. When stratifying for sex, the age-adjusted hazard ratios for other cancers were 1.54 (95% CI, 1.08 to 2.18) for women and 1.37 (95% CI, 1.01 to 1.85) for men (sex difference: P = .63). For CHEK2*1100delC heterozygotes compared with noncarriers, the age- and sex-adjusted hazard ratios were 5.76 (95% CI, 2.12 to 15.6) for stomach cancer, 3.61 (95% CI, 1.33 to 9.79) for kidney cancer, 3.45 (95% CI, 1.09 to 10.9) for sarcoma, and 1.60 (95% CI, 1.00 to 2.56) for prostate cancer. Conclusion CHEK2*1100delC heterozygosity is associated with 15% to 82% increased risk for at least some cancers in addition to breast cancer. This information may be useful in clinical counseling of patients with this loss-of-function mutation.

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