scholarly journals QTc Intervals Are Prolonged in Late Preterm and Term Neonates during Therapeutic Hypothermia but Normalize Afterwards

Children ◽  
2021 ◽  
Vol 8 (12) ◽  
pp. 1153
Author(s):  
Karel Allegaert ◽  
Thomas Salaets ◽  
Robert M. Ward ◽  
Pieter Annaert ◽  
Anne Smits
Keyword(s):  
Body Temperature ◽  
Therapeutic Hypothermia ◽  
Newborn Infant ◽  
Reference Values ◽  
Qtc Interval ◽  
Neonatal Encephalopathy ◽  
Qtc Prolongation ◽  
Specific Population ◽  
Individual Values ◽  
Term Neonates

Background: There are anecdotal reports on reversible QTc prolongation during therapeutic hypothermia (TH) for moderate to severe neonatal encephalopathy after asphyxia. As the QTc interval is a relevant biomarker for pharmacovigilance during medication development, a structured search and review on published neonatal QTc values to generate reference values is warranted to facilate medication development in this specific population. Methods: A structured search and literature assessment (PubMed, Embase, and Google Scholar) with ‘Newborn/Infant, QT and hypothermia’ was conducted (October 2021). Retrieved individual values were converted to QTc (Bazett) over postnatal age (day 1–7). Results: We retrieved 94 QTc intervals (during TH (n = 50, until day 3) or subsequent normothermia (n = 44, day 4–7)) in 33 neonates from 6 publications. The median (range) of QTc intervals during TH was 508 (430–678), and 410 (317–540) ms afterwards (difference 98 ms, or +28 ms/°C decrease). Four additional cohorts (without individual QTc intervals) confirmed the pattern and magnitude of the effect of body temperature on the QTc interval. Conclusions: We highlighted a relevant non-maturational covariate (°C dependent TH) and generated reference values for the QTc interval in this specific neonatal subpopulation. This knowledge on QTc during TH should be considered and integrated in neonatal medication development.

scholarly journals QTc Intervals Are Prolonged in Late Preterm and Term Neonates During Therapeutic Hypothermia but Normalize Afterwards

2021 ◽  
Author(s):  
Karel Allegaert ◽  
Thomas Salaets ◽  
Robert M. Ward ◽  
Pieter Annaert ◽  
Anne Smits
Keyword(s):  
Body Temperature ◽  
Therapeutic Hypothermia ◽  
Newborn Infant ◽  
Reference Values ◽  
Qtc Interval ◽  
Neonatal Encephalopathy ◽  
Qtc Prolongation ◽  
Specific Population ◽  
Individual Values ◽  
Term Neonates

Background: There are anecdotal reports on reversible QTc prolongation during therapeutic hypothermia (TH) for moderate to severe neonatal encephalopathy after asphyxia. As the QTc interval is a relevant biomarker to assess safety during medication development, a structured search and review on published neonatal QTc values to generate reference values is warranted to facilate medication development in this specific population. Methods: A structured search and literature assessment (PubMed, Embase, Google Scholar) with ‘Newborn/Infant, QT and hypothermia’ was conducted (October 2021). Retrieved individual values were converted to QTc (Bazett) over postnatal age (day 1-7). Results: We retrieved 94 QTc intervals [during TH (n=50, until day 3) or subsequent normothermia (n=44, day 4-7)] in 33 neonates from 6 publications. The median (range) of QTc intervals during TH was 508 (430-678), and 410 (317-540) ms afterwards (difference 98 ms, or +28 ms/°C decrease). Four additional cohorts (without individual QTc intervals) confirmed the pattern and magnitude of the effect of body temperature on the QTc interval. Conclusions: We added a relevant non-maturational covariate (TH, °C dependent) and generated reference values for the QTc interval in this specific neonatal subpopulation. This knowledge on QTc during TH should be considered and integrated in neonatal medication development.

Abstract 157: The Association Between Serum Magnesium Levels and Qt Interval Duration During Therapeutic Hypothermia and its Effects on Neurological Outcomes

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Manish Kumar ◽  
William Perucki ◽  
Brett Hiendlmayr ◽  
David O’Sullivan ◽  
Silya Mazigh ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Serum Magnesium ◽  
Inverse Correlation ◽  
The United States ◽  
Temperature Management ◽  
Qtc Interval ◽  
Qtc Prolongation ◽  
Neurological Outcomes ◽  
Neurologic Outcomes

Introduction: Sudden cardiac arrest is a major cause of mortality in the United States and globally. Therapeutic hypothermia (TH) has demonstrated success in improving neurological outcomes in post-cardiac arrest patients. TH causes several physiologic ECG changes, including QTc prolongation. TH also decreases serum magnesium levels. These changes may lead to malignant ventricular arrhythmia and poor neurological outcome. We aimed to evaluate the association between the QTc interval during TH, magnesium levels, and neurologic outcomes. Methods: We reviewed the electrocardiograms of 366 patients who underwent TH at various intervals corresponding to pre-cooling, maintenance of targeted temperature management, and rewarming periods. We reviewed the change in the corrected QT segment (QTc) and evaluated their relationship with the patients’ magnesium levels and neurologic outcomes. Results: 71.3% of the patients had a significant increase in QTc interval defined as >60 ms or any QTc>500 ms during TH. Patients with persistent prolongation of QTc after rewarming had poor neurological outcomes (p<0.05). Magnesium level showed a positive correlation with QTc interval at presentation (R=0.240, p<0.05) and at 48 hours (R=0.225, p= <0.05). Patients who had poor neurological outcomes tended to have higher magnesium levels at presentation (p<0.05). The majority of patients who received supplemental Mg did not have any significant change in their QTc. Conclusion: TH is independently associated with QTc prolongation. Patients with a persistent increase in QTc interval during the rewarming phase should be promptly evaluated for QTc-prolonging factors given its association with worse neurological outcomes. The inverse correlation between magnesium levels and poor neurological outcomes deserves further investigation.

Management of Comfort and Sedation in Neonates with Neonatal Encephalopathy Treated with Therapeutic Hypothermia

2021 ◽  
pp. 101264
Author(s):  
Christopher McPherson ◽  
Adam Frymoyer ◽  
Cynthia M. Ortinau ◽  
Steven P. Miller ◽  
Floris Groenendaal
Keyword(s):  
Therapeutic Hypothermia ◽  
Neonatal Encephalopathy

scholarly journals Coronavirus disease 2019 (COVID-19) and QTc prolongation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Khalid Changal ◽  
David Paternite ◽  
Sean Mack ◽  
Spiro Veria ◽  
Rehana Bashir ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Enzyme Inhibitors ◽  
Cardiac Injury ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Qtc Interval ◽  
Qtc Prolongation ◽  
Converting Enzyme Inhibitors ◽  
Stage Renal Disease ◽  
End Stage ◽  
Relationship Of

Abstract Introduction The cause-and-effect relationship of QTc prolongation in Coronavirus disease 2019 (COVID-19) patients has not been studied well. Objective We attempt to better understand the relationship of QTc prolongation in COVID-19 patients in this study. Methods This is a retrospective, hospital-based, observational study. All patients with normal baseline QTc interval who were hospitalized with the diagnosis of COVID-19 infection at two hospitals in Ohio, USA were included in this study. Results Sixty-nine patients had QTc prolongation, and 210 patients continued to have normal QTc during hospitalization. The baseline QTc intervals were comparable in the two groups. Patients with QTc prolongation were older (mean age 67 vs. 60, P 0.003), more likely to have underlying cardiovascular disease (48% versus 26%, P 0.001), ischemic heart disease (29% versus 17%, P 0.026), congestive heart failure with preserved ejection fraction (16% versus 8%, P 0.042), chronic kidney disease (23% versus 10%, P 0.005), and end-stage renal disease (12% versus 1%, P < 0.001). Patients with QTc prolongation were more likely to have received hydroxychloroquine (75% versus 59%, P 0.018), azithromycin (18% vs. 14%, P 0.034), a combination of hydroxychloroquine and azithromycin (29% vs 7%, P < 0.001), more than 1 QT prolonging agents (59% vs. 32%, P < 0.001). Patients who were on angiotensin-converting enzyme inhibitors (ACEi) were less likely to develop QTc prolongation (11% versus 26%, P 0.014). QTc prolongation was not associated with increased ventricular arrhythmias or mortality. Conclusion Older age, ESRD, underlying cardiovascular disease, potential virus mediated cardiac injury, and drugs like hydroxychloroquine/azithromycin, contribute to QTc prolongation in COVID-19 patients. The role of ACEi in preventing QTc prolongation in COVID-19 patients needs to be studied further.

scholarly journals Cost-Effectiveness of Therapeutic Hypothermia to Treat Neonatal Encephalopathy

2010 ◽  
Vol 13 (6) ◽  
pp. 695-702 ◽  
Author(s):  
Dean A. Regier ◽  
Stavros Petrou ◽  
Jane Henderson ◽  
Oya Eddama ◽  
Nishma Patel ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Therapeutic Hypothermia ◽  
Neonatal Encephalopathy

Effect of early suckling on term neonates' core body temperature

1990 ◽  
Vol 10 (4) ◽  
pp. 347-353 ◽  
Author(s):  
C. A. Van Den Bosch ◽  
C. H. W. Bullough
Keyword(s):  
Body Temperature ◽  
Core Body Temperature ◽  
Term Neonates ◽  
Core Body

scholarly journals Predictive Role of QTc Prolongation in Carbon Monoxide Poisoning-Related Delayed Neuropsychiatric Sequelae

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Shu-Chen Liao ◽  
Yan-Chiao Mao ◽  
Yao-Min Hung ◽  
Ching-Hsing Lee ◽  
Chen-Chang Yang
Keyword(s):  
Carbon Monoxide ◽  
Roc Curve ◽  
Carbon Monoxide Poisoning ◽  
Chang Gung Memorial Hospital ◽  
Qtc Interval ◽  
Continuous Variables ◽  
Co Poisoning ◽  
Qtc Prolongation ◽  
Roc Curve Analysis ◽  
Delayed Neuropsychiatric Sequelae

Objective. Delayed neuropsychiatric sequelae (DNS) are serious complications of carbon monoxide (CO) poisoning that adversely affect poisoned patients’ quality of life as well as socioeconomic status. This study aimed to determine clinical predictors of DNS in patients with CO poisoning. Methods. This retrospective study included all CO-poisoned patients admitted to the emergency department (ED) of Linkou Chang Gung Memorial Hospital in Taiwan from 1 January 2009 to 31 December 2015. The medical records of all patients with CO poisoning were carefully reviewed, and relevant data were abstracted into a standardised form. Univariate and multivariate logistic regression models were used to identify predictors of DNS after CO poisoning. Receiver operating characteristic (ROC) curve analysis was used to determine the ideal cut-off value for continuous variables that predict the development of DNS. Results. A total of 760 patients with CO poisoning were identified during the study period. Among them, 466 were eligible for the analysis of predictors of DNS. In multivariate analysis, Glasgow Coma Scale <9 (odds ratio [OR], 2.74; 95% confidence interval [CI], 1.21–6.21), transient loss of consciousness (OR, 3.59; 95% CI, 1.31–9.79), longer duration from CO exposure to ED presentation (OR, 1.05; 95% CI, 1.03–1.08), and corrected QT (QTc) prolongation (OR, 2.61; 95% CI, 1.21–5.61) were found to be associated with a higher risk of DNS. The area under the ROC curve (AUC) for QTc interval measured within 6 h after exposure best predicted the development of DNS, with a result of 0.729 (95% CI 0.660–0.791). Moreover, the best cut-off value of the QTc interval was 471 ms, with a sensitivity of 53.3% and a specificity of 85.1%. Conclusions. We identified several potential predictors of DNS following CO poisoning. Among them, QTc prolongation found within 6 h after exposure is a novel predictor of DNS, which may be helpful in the future care of patients with CO poisoning.

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