A Survey of Academic Neonatologists on Neonatal Electrical Cardioversion and Defibrillation

Objective: Assess neonatologists’ experience and comfort with neonatal electrical cardioversion or defibrillation (EC-D). Study Design: Electronic surveys were distributed to academic neonatologists affiliated with 12 Midwest academic hospitals. Neonatologists were asked about their residency training; years since completing residency; current certification/ competency training in BLS, PALS, ACLS and NRP; experiences with EC-D; availability of a pediatric cardiologist and their comfort levels with such procedures. Standard statistical tests evaluated comfort with EC-D. Results: Seventy-two out of 180 neonatologists responded to the survey (response rate=40%). 98.6% (71), 54.2% (39) and 37.5% (27) maintained current NRP, BLS and PALS training respectively. 73.6% (n=53) reported having performed neonatal EC-D. Of those, 50.9% (n=27) indicated feeling slightly to very uncomfortable performing EC-D. We report a lack of BLS certification being associated with lack of comfort (OR: 0.269 - 95% CI [0.071, 0.936]), and a positive association between a pediatric cardiologist being present and being uncomfortable (OR: 3.722 – 95% CI [1.069,14.059]). Those reporting greater volume and more recent experience with EC-D report more comfort. Conclusion: Of neonatologists that performed EC-D, half reported being uncomfortable. BLS certification and experience are positively associated with comfort in performing EC-D. Simulations to increase training in EC-D should be offered regularly to academic neonatologists.

QT Interval Changes in Children With Febrile Convulsion Comparing With Healthy

A temperature-related seizure is a febrile seizure that affects the QT interval. The purpose of this study was to evaluate the changes in the QT interval caused by febrile convulsion compared with healthy children. Method This case-control study considered the distribution of 180 children equally shared between patients and controls. The study was conducted at the "Ali Ebne Abi Talib" Hospital in Zahedan, Iran. The disease diagnosed and confirmed based on standard definitions of febrile convulsion. QT interval measured by ECG and interpreted by a pediatric cardiologist and collected data were analyzed with SPSS 19 considering 0.05 as significant error. Results Among the ECG parameters, HR, R in aVL, S in V3, LVM, QTd, QTc and QTcd were significantly different in children with febrile convulsion compared to the peers. From those who had abnormal QTd, FC children were more frequented but not significant (CHI SQUARE=1.053, p=0.248), when children with FC were more in abnormality regarding QTc (CHI SQUARE=13.032, p<0.001) and QTcd (CHI SQUARE=21.6, P<0.001) significantly. In children with FC, those who were aged less than 12 months, had the highest level of HR but not significant (CHI SQUARE=4.59, p=0.101). Similar trends occurred for R in aVL and S in V3 that were higher in the age group >24 months (p>0.05). LVM had the highest value in the age group of >24 months significantly (CHI SQUARE= 52.674, P<0.001) and the other QT parameters were same in Fc children with different age groups (P>0.05). Conclusion From the study concluded that dispersion corrected QT, corrected QT and dispersion QT changed significantly in children with febrile convulsion in comparing with the healthy children but with constant values in children with FC in different age groups.

First symptoms of prenatally undetected heart defects

Background: Severe or critical congenital heart defects (CHDs) are 35% of those detected only after birth. The aim of the study was to measure the incidence of these CHDs, identify their clinical symptoms, and determine individual risk periods for CHD manifestation. Methods: This retrospective cohort study was conducted from 2009 to 2018 in a population of 175,153 live births. Occurrence of the first symptoms of CHD was noted as early neonatal (0–7 days), late neonatal (8–28 days), in early infancy (1–6 months), or in late infancy (6–12 months). The first symptom for which the child was referred to a pediatric cardiologist was defined as a symptom of CHD. Results : There were 598 severe CHDs diagnosed (3.3 cases/1000), and 70% were isolated anomalies. A concomitant genetic disorder was diagnosed in 20%, and extracardiac pathology with a normal karyotype was present in 10%. Of the total, 53% of CHDs were detected prenatally and excluded. The remaining 47% developed CHD symptoms postnatally. Of these, 74% were diagnosed as early neonates, 16% as late neonates, and 10% as infants. Defects requiring repeated operations manifested significantly earlier than those with requiring one primary correction. The most common symptoms leading to the diagnosis of CHD were heart murmur and cyanosis. Conclusions : Despite the effectiveness of prenatal diagnosis, some children will be born with undiagnosed major heart defects. Assessment of symptoms and early detection of the defect is crucial.

Role of a schematic figure of echocardiography in congenital heart diseasessurgery: which method of reporting do you prefer?

Congenital structural heart diseases are the most commonly reported fatal anomalies in children. These anatomical disorders often can be corrected surgically .Today, echocardiography is the best and most important diagnostic technique for anatomical abnormalities in the heart. In this method, by using the ultrasound waves (sonography), anatomical details, and hemodynamic examination of the heart can be determined . Most pediatric cardiologists provide echocardiographic reports in the form of handwriting or typed text. This method of reporting is sometimes unable to understand the structural anomalies precisely and accurately for the final decision. Nowadays, 2-dimensional echocardiography is acceptable for the diagnosis of some structural heart abnormalities accurately. Even there is no necessary to angiography for surgical planning .2 But sometimes lack matching echocardiographic findings with surgical reports, it seems that adding a schematic figure base on echocardiography findings from the viewpoint of pediatric cardiologist will be the helper to the congenital cardiac surgeon. This proposed method of reporting will lead to the promotion of surgical treatment in congenital heart diseases. The history of the schematic picture in the anatomical textbook for a better understanding of subjects and also diseases has been shown previously by famous painters like Leonardo Davin chi. This suggestion shows that mapping can be viewed as a common language for better understanding of echocardiographic reports and more adaptation between comments of a pediatric cardiologist with designing congenital cardiac surgeon for more precise and complete treatment.