Abstract：
BACKGROUND: Myocardial development is still transitioning by the time of birth making the cardiomyocyte vulnerable to maternal and perinatal factors. We aimed at investigating the impact of maternal and perinatal factors on the neonatal electrocardiogram.
METHODS: In a prospective cohort study, neonates underwent cardiac evaluation with electrocardiograms and echocardiograms (age 0-30 days). Associations between medical and demographic data, pregnancy, and birth-related factors, and electrocardiographic parameters were assessed.
RESULTS: A total of 15,928 singletons with normal echocardiograms were included (52% boys). Neonates were divided into groups by accumulated number of maternal/perinatal factors: 0, 1, 2, 3, 4, and ≥5, and between-group differences in electrocardiographic parameters were analysed. We observed an additive effect with a leftward shift of the QRS axis and QT prolongation (all p < 0.01). Comparing extreme groups (0 vs. ≥5 maternal/perinatal factors), we found a 4.3% more left-shifted QRS axis (117 vs. 112°, p < 0.001) and a 0.8% prolonged QTcFridericia (QTcF; 363 vs. 366 ms, p < 0.001); the effect on QTcF was most pronounced in neonates examined in the first week of life (360 vs. 368 ms, p < 0.0001).
CONCLUSIONS: We observed a cumulative effect of maternal and perinatal factors on neonatal electrocardiographic parameters, including a more left-shifted QRS axis and increased QT duration, although the variation was within normal reference ranges. Our findings add to the knowledge on the neonatal cardiac transition and the cardiac effect of maternal/perinatal factors.
METHODS: In a prospective cohort study, neonates underwent cardiac evaluation with electrocardiograms and echocardiograms (age 0-30 days). Associations between medical and demographic data, pregnancy, and birth-related factors, and electrocardiographic parameters were assessed.
RESULTS: A total of 15,928 singletons with normal echocardiograms were included (52% boys). Neonates were divided into groups by accumulated number of maternal/perinatal factors: 0, 1, 2, 3, 4, and ≥5, and between-group differences in electrocardiographic parameters were analysed. We observed an additive effect with a leftward shift of the QRS axis and QT prolongation (all p < 0.01). Comparing extreme groups (0 vs. ≥5 maternal/perinatal factors), we found a 4.3% more left-shifted QRS axis (117 vs. 112°, p < 0.001) and a 0.8% prolonged QTcFridericia (QTcF; 363 vs. 366 ms, p < 0.001); the effect on QTcF was most pronounced in neonates examined in the first week of life (360 vs. 368 ms, p < 0.0001).
CONCLUSIONS: We observed a cumulative effect of maternal and perinatal factors on neonatal electrocardiographic parameters, including a more left-shifted QRS axis and increased QT duration, although the variation was within normal reference ranges. Our findings add to the knowledge on the neonatal cardiac transition and the cardiac effect of maternal/perinatal factors.
摘要：
背景：心肌发育仍在出生时过渡，使心肌细胞容易受到母体和围产期因素的影响。我们旨在调查母体和围产期因素对新生儿心电图的影响。
方法：在一项前瞻性队列研究中，新生儿接受了心电图和超声心动图的心脏评估(年龄0~30天).医疗和人口统计数据之间的关联，怀孕,和出生相关因素，和心电图参数进行评估。
结果：共纳入了15,928例超声心动图正常的单身人士（52％的男孩）。根据产妇/围产期因素的累积数量将新生儿分为：0、1、2、3、4和≥5组，并分析了心电图参数的组间差异。我们观察到QRS轴向左移动和QT延长的加性效应(均p<0.01)。比较极端群体（0与≥5个孕产妇/围产期因素)，我们发现左移QRS轴增加了4.3%（117与112°,p<0.001）和0.8%的QTcFridericia延长（QTcF；363与366ms,p＆lt;0.001）；对QTcF的影响在出生后第一周检查的新生儿中最为明显（360vs.368ms,p<0.0001)。
结论：我们观察到母体和围产期因素对新生儿心电图参数的累积影响，包括更左移的QRS轴和增加的QT持续时间，尽管变化在正常参考范围内。我们的发现增加了对新生儿心脏转换和母体/围产期因素对心脏的影响的认识。
方法：在一项前瞻性队列研究中，新生儿接受了心电图和超声心动图的心脏评估(年龄0~30天).医疗和人口统计数据之间的关联，怀孕,和出生相关因素，和心电图参数进行评估。
结果：共纳入了15,928例超声心动图正常的单身人士（52％的男孩）。根据产妇/围产期因素的累积数量将新生儿分为：0、1、2、3、4和≥5组，并分析了心电图参数的组间差异。我们观察到QRS轴向左移动和QT延长的加性效应(均p<0.01)。比较极端群体（0与≥5个孕产妇/围产期因素)，我们发现左移QRS轴增加了4.3%（117与112°,p<0.001）和0.8%的QTcFridericia延长（QTcF；363与366ms,p＆lt;0.001）；对QTcF的影响在出生后第一周检查的新生儿中最为明显（360vs.368ms,p<0.0001)。
结论：我们观察到母体和围产期因素对新生儿心电图参数的累积影响，包括更左移的QRS轴和增加的QT持续时间，尽管变化在正常参考范围内。我们的发现增加了对新生儿心脏转换和母体/围产期因素对心脏的影响的认识。
