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 < .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.

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.

The Difference Between Unfixed and Postfixation Placental Weight

2019 ◽  
Vol 152 (2) ◽  
pp. 217-220 ◽  
Author(s):  
Rosemary Tambouret ◽  
William R Jeck ◽  
Drucilla J Roberts
Keyword(s):  
Reference Values ◽  
Gestational Age ◽  
T Test ◽  
Placental Weight ◽  
Significant Gain ◽  
Fresh State ◽  
Reference Weight ◽  
The Difference ◽  
The Impact ◽  
Paired T Test

ABSTRACT Objectives Reference values for placental weights correlated with gestational age are used in surgical pathology. Most reference values were established for fresh placentas. Some laboratories routinely fix all placentas, bringing into question the accuracy of the reference weight values. We wanted to determine the impact of fixation on placental weight. Methods One hundred placentas from uncomplicated pregnancies were weighed in the fresh state, after removal of the cord and membranes. After fixation in formalin for 1 day and 5 days, the placentas were reweighed. The change in weight for each placenta was analyzed by a two-tailed paired t test. Results Statistically, a small but significant gain in weight occurred after 24 hours (3.7%, P << .001), and there was no significant change identified in the additional 4 days (P = .51). Nine placentas lost weight with fixation; the weight of four was unchanged. Conclusions We consider formalin fixation to add a statistically significant but clinically negligible amount of weight to the placenta.

Gestational age-specific reference values of placental thickness in normal pregnant women

2019 ◽  
Vol 59 (7) ◽  
pp. 718-729 ◽  
Author(s):  
E. Keshavarz ◽  
M. Motevasselian ◽  
B. Amirnazeri ◽  
S. Bahramzadeh ◽  
H. Mohammadkhani ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Reference Values ◽  
Gestational Age ◽  
Specific Reference ◽  
Placental Thickness

scholarly journals Ethnic-specific reference range affects the efficacy of quadruple test as a universal screening for Down syndrome in a developing country

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251381
Author(s):  
Savitree Pranpanus ◽  
Ounjai Kor-anantakul ◽  
Thitima Suntharasaj ◽  
Chitkasaem Suwanrath ◽  
Tharangrut Hanprasertpong ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Gestational Age ◽  
False Positive ◽  
Detection Rate ◽  
Reference Range ◽  
Risk Estimation ◽  
False Positive Rate ◽  
Specific Reference ◽  
The Impact ◽  
Ethnic Factor

Objective To evaluate the efficacy of the quadruple test for potential use as a Thai national policy for Down syndrome (DS) screening and establish an accurate equation for risk estimation of Down syndrome based on gestational age, weight and the ethnic-specific reference range of our population. Methods A prospective study was conducted on singleton pregnancies at 14 to 21 weeks of gestation to evaluate the efficacy of quadruple DS screening using the automatically calculated Western European descent factor (WF) in our population and the impact of screening using a specific Thai ethnic factor as well as to establish an equation for the risk estimation of DS based on gestational age, weight and a local Thai ethnic factor to correct for the impact of ethnic factor on the screening efficacy. Results Of a total of 5,515 women, 12 cases of DS and 8 cases of other aneuploidies were found. The detection rate, false positive rate and specificity were 75.0%, 9.1% and 90.9%, respectively, by automatic calculation with the widely used WF; the screening efficacy was lower when used in Asian populations than in other studies. The best-fitted regression equation of serum quadruple screening of AFP, free β-hCG, uE3 and inhibin A was established by adjustment for gestational age (GA) in days, maternal weight and our Thai-specific ethnic reference range which was created for this study. Calculations with our Thai-specific ethnic model gave a better detection rate of 83.3%, a false positive rate of 9.6% and specificity of 90.4%. Conclusion The serum quadruple test had a lower detection rate than expected when the risk estimation was based on the WF reference range. The serum quadruple test using WF had significantly different levels when corrected with our ethnic-specific factor. Using our local ethnic specific model could increase the detection rate of DS screening in Thailand with a minimal increase in false positive rates. Our findings indicate that DS screening should be adjusted with an appropriate individual ethnic factor when used for national screening.

scholarly journals Weight Development in Children After Gastric Bypass Surgery

2020 ◽  
Author(s):  
Linda Larsson ◽  
Mona Landin-Olsson ◽  
Charlotta Nilsson
Keyword(s):  
Gastric Bypass ◽  
Reference Values ◽  
Gestational Age ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Specific Reference ◽  
Obese Women ◽  
Clear Pattern ◽  
Short Term

Objective: More and more young obese women get pregnant after undergoing gastric bypass surgery (GBP) but little is known about weight development in their offspring. The first aim of this study was to investigate weight development of children whose mothers have undergone GBP before pregnancy and compare them to age specific reference values in Sweden. Second aim was to study the frequency of small for gestational age (SGA) in this population. Materials and methods: Weight of offspring (38 male and 28 female) where the mother had undergone GBP before pregnancy were studied from birth up to 18 months of age and compared to age-specific reference values in Sweden. Results: The boys to mothers who had undergone GBP before pregnancy weighed more than Swedish reference values at 6 months, 8.44 ± 1.18 kilogram (kg) (n = 35) vs. 7.98 ± 0.81 kg (n = 1388; p = 0.001), and less at 18 months, 11.54 ± 0.93 kg (n = 19) vs. 12.27 ± 1.19 kg (n = 862; p < 0.001). The girls to mothers who had undergone GBP before pregnancy weighed more than Swedish reference values at 6 months, 7.84 ± 1.00 kg (n = 28) vs. 7.50 ± 0.77 kg (n = 1375; p = 0.020). Frequency of SGA was 3.0%. Conclusion: No clear pattern was found concerning the short-term weight development of the children. However, studies with larger material and more follow up time must be performed.  

Contemporary Qur'anic Studies in Iran and its Relationship with Qur'anic Studies in the West

2012 ◽  
Vol 14 (1) ◽  
pp. 45-72
Author(s):  
Morteza Karimi-Nia
Keyword(s):  
Islamic Law ◽  
Human Sciences ◽  
The West ◽  
Communications Technologies ◽  
Religious Learning ◽  
The Status ◽  
Islamic Republic Of Iran ◽  
Almost All ◽  
The Impact ◽  
The Relationship

The status of tafsīr and Qur'anic studies in the Islamic Republic of Iran has changed significantly during recent decades. The essay provides an overview of the state of Qur'anic studies in Iran today, aiming to examine the extent of the impact of studies by Western scholars on Iranian academic circles during the last three decades and the relationship between them. As in most Islamic countries, the major bulk of academic activity in Iran in this field used to be undertaken by the traditional ʿulamāʾ; however, since the beginning of the twentieth century and the establishment of universities and other academic institutions in the Islamic world, there has been increasing diversity and development. After the Islamic Revolution, many gradual changes in the structure and approach of centres of religious learning and universities have occurred. Contemporary advancements in modern sciences and communications technologies have gradually brought the institutions engaged in the study of human sciences to confront the new context. As a result, the traditional Shīʿī centres of learning, which until 50 years ago devoted themselves exclusively to the study of Islamic law and jurisprudence, today pay attention to the teaching of foreign languages, Qur'anic sciences and exegesis, including Western studies about the Qur'an, to a certain extent, and recognise the importance of almost all of the human sciences of the West.

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