Electrocardiogram In Infants Research Articles

Infants Autonomic Cardio- Respiratory Responses to Nurturing Stroking Touch Delivered by the Mother or the Father.

The building of physiological self-regulation during bonding is a crucial developmental process based on early cardio-respiratory maturation. The mother’s role as a facilitator of this physiological maturation has been evidenced and recognized in many respects. Research in fathers, however, remains sparse which may be due to the belief that bonding is a physiological behavior reserved for a mother’s maternal instinct. In the current study we compared the impact of paternal and maternal nurturing stroking touch on infants’ physiological self-regulation in terms of respiratory sinus arrhythmia (RSA). We compared the impact of a 3-min stroking period (STROKING) with a pre-baseline (PRE-STROKING) and post-baseline (POST-STROKING) of 25 mothers and 25 fathers (unrelated to one another) on their infants, aged 4–16 weeks. We registered infant electrocardiogram (ECG) and respiration to calculate infant RR-interval (RRI), respiration rate (fR) and (respiratory corrected) RSA (RSAcorr). Based on video-recordings, we analyzed the stroking speed. Infants’ RSAcorr significantly increased during and after stroking, no matter whether touch was delivered by fathers or mothers. This effect was mediated by both heart rate (HR) and respiration. However, respiratory mediation occurred later when delivered by fathers than by mothers. Both mothers’ and fathers’ stroking speed occurred within the optimal stimulation range of c-tactile (CT) afferents, a particular class of cutaneous unmyelinated, low-threshold mechano-sensitive nerves hypothesized to be involved in inter-personal bonding. The discussion builds on the idea to mitigate fathers’ doubts about their paternal capabilities and proposes a research agenda regarding the further examination of the role of nurturing touch and its underlying mechanisms within the development of infants’ physiological self-regulation. Finally, the importance of respiratory measurements in infant physiological research is emphasized.

The Welch Emotional Connection Screen: validation of a brief mother-infant relational health screen.

The Welch Emotional Connection Screen (WECS), assesses mother-infant Emotional Connection in clinical settings. It includes: Attraction, Vocal Communication, Facial Communication, Sensitivity/Reciprocity and clinical decision of Emotional Connection (yes/no). We tested concurrent and construct validity of the WECS and associations with behavioural and physiological measures in preterm infants. Videos from 76 mothers-infants (gestational age 36 weeks) during an in-NICU caregiving paradigm were coded for maternal caregiving behaviour. Videos of mothers-infants were also obtained at 4 months during 10 minutes of face-to-face play (coded with WECS and for maternal positivity and infant social engagement) and the still-face paradigm (coded for infant behavioural approach towards mother; infant electrocardiogram acquired in vivo). WECS maternal scores were positively associated with maternal sensitivity and quality of vocal contact at 36 weeks (caregiving) and maternal positivity at 4 months (face-to-face). WECS infant scores positively correlated with infant social engagement and maternal positivity during face-to-face interactions at 4 months. Infants from emotionally not connected dyads (vs. emotionally connected dyads) displayed autonomic dysregulation and less approach-seeking behaviour towards mother during interactive/play sessions of the still-face paradigm. This preliminary evidence supports the WECS as a valid screen for rating mother-preterm infant emotional connection associated with healthier infant biobehavioural stress responding.

Bayesian Wavelet Shrinkage of the Haar-Fisz Transformed Wavelet Periodogram.

It is increasingly being realised that many real world time series are not stationary and exhibit evolving second-order autocovariance or spectral structure. This article introduces a Bayesian approach for modelling the evolving wavelet spectrum of a locally stationary wavelet time series. Our new method works by combining the advantages of a Haar-Fisz transformed spectrum with a simple, but powerful, Bayesian wavelet shrinkage method. Our new method produces excellent and stable spectral estimates and this is demonstrated via simulated data and on differenced infant electrocardiogram data. A major additional benefit of the Bayesian paradigm is that we obtain rigorous and useful credible intervals of the evolving spectral structure. We show how the Bayesian credible intervals provide extra insight into the infant electrocardiogram data.

A Test for Second-Order Stationarity and Approximate Confidence Intervals for Localized Autocovariances for Locally Stationary Time Series

SummaryMany time series are not second order stationary and it is not appropriate to analyse them by using methods designed for stationary series. The paper introduces a new test for second-order stationarity that detects kinds of departures from stationarity that are different from those based on Fourier methods. The new test is also computationally fast, designed to work with Gaussian and a wide range of non-Gaussian time series, and can locate non-stationarities in time and scale. The test is demonstrated on earthquake, explosion, infant electrocardiogram and simulated time series showing varying degrees of stationarity. The second main contribution develops approximate confidence intervals for time varying autocovariances for locally stationary series as the usual bands computed for stationary series are not appropriate. Our new bands enable practitioners to assess time varying autocovariances statistically and are exhibited on localized autocovariances of explosion and simulated time series.

The Measurement of the QT and QTc on the Neonatal and Infant Electrocardiogram: A Comprehensive Reliability Assessment

An electrocardiogram has been proposed to screen for prolonged QT interval that may predispose infants to sudden death in the first year of life. Understanding the reliability of QT interval measurement will inform the design of a screening program. Three pediatric cardiologists measured the QT/RR intervals on 60 infant electrocardiograms (median age 46 days), from leads II, V5 and V6 on three separate occasions, 7 days apart, according to a standard protocol. The QTc was corrected by Bazett's (QTcB), Fridericia's (QT(CFrid)), and Hodges' (QTcH) formulae. Intraobserver and interobserver reliability were assessed by intraclass correlation coefficients (ICC), limits of agreement and repeatability coefficients for single, average of two and average of three measures. Agreement for QTc prolongation (> 440 msec) was assessed by kappa coefficients. QT interval intraobserver ICC was 0.86 and repeatability coefficient was 25.9 msec; interobserver ICC increased from 0.88 for single observations to 0.94 for the average of 3 measurements and repeatability coefficients decreased from 22.5 to 16.7 msec. For QTcB, intraobserver ICC was 0.67, and repeatability was 39.6 msec. Best interobserver reliability for QTcB was for the average of three measurements (ICC 0.83, reproducibility coefficient 25.8 msec), with further improvement for QTcH (ICC 0.92, reproducibility coefficient 16.69 msec). Maximum interobserver kappa for prolonged QTc was 0.77. Misclassification around specific cut points occurs because of the repeatability coefficients. Uncorrected QT measures are more reliable than QTcB and QT(CFrid). An average of three independent measures provides the most reliable QT and QTc measurements, with QTcH better than QTcB.

Antenatal Use of Selective Serotonin-Reuptake Inhibitors and QT Interval Prolongation in Newborns

Prolongation of the QT interval is a risk factor for sudden death. Selective serotonin-reuptake inhibitor antidepressants can prolong the QT interval and are widely used by pregnant women. Whether antenatal exposure to selective serotonin-reuptake inhibitor causes QT prolongation in offspring is unknown. The aim of this study was to determine the effect of maternal use of selective serotonin-reuptake inhibitor antidepressants during pregnancy on the QTc interval of the offspring. Between January 2000 and December 2005, we collected data on all of the newborns born at a single tertiary care hospital. Electrocardiograms of infants exposed to selective serotonin-reuptake inhibitor antidepressants in utero were compared with those of healthy control newborns matched on gestational age. The tracings were interpreted by a pediatric cardiologist who was unaware of the drug exposure. We identified 52 newborns exposed to selective serotonin-reuptake inhibitor antidepressants in the immediate antepartum period and 52 matched control subjects. The mean QTc was significantly longer in the group of newborns exposed to antidepressants as compared with control subjects (409 +/- 42 vs 392 +/- 29 milliseconds). Five (10%) newborns exposed to selective serotonin-reuptake inhibitor antidepressants had a markedly prolonged QTc interval (>460 milliseconds) compared with none of the unexposed newborns. The longest QTc interval observed among exposed newborns was 543 milliseconds. All of the drug-associated repolarization abnormalities normalized in subsequent electrocardiographic tracings. Antepartum use of selective serotonin-reuptake inhibitor antidepressants is associated with QTc interval prolongation in exposed neonates. Additional research using a standardized protocol is needed to determine whether exposure to selective serotonin-reuptake inhibitor antidepressants in late pregnancy is also associated with arrhythmias.

High prevalence of widened P waves among pediatric patients in 2 separate hospitals

Introduction In adults, P waves of 110 milliseconds or longer are often associated with significant disease. In the pediatric population, however, cutoffs for P-wave durations are naturally lower but could vary physiologically with age because of increasing heart mass. We appraised if age-proportionate increase in P-wave duration does indeed occur in both hospitalized infants and children and also investigated the prevalence of widened P-wave durations using currently accepted “normal” cutoffs (≤70 milliseconds for infants and ≤90 milliseconds for children). Methods We consecutively obtained 12-lead electrocardiograms of infants and children aged up to 16 years (range, 0.1-16 years; mean ± SD, 10.1 ± 5.2 years; male, 46.9%) who presented through the emergency department for nonacute, noncardiac conditions at the Nassau University Medical Center (NUMC), East Meadow, NY, and Saint Vincent Hospital (SVH), Worcester, MA, from January to May 2006. Electrocardiograms were then evaluated for the greatest P-wave duration in every lead to the nearest 10 milliseconds using a calibrated magnifying graticule on a blinded, single read. Results The study sample consisted of 96 nonacute pediatric patients: infants and children from NUMC (age, 0.1-16 years; mean ± SD, 9.1 ± 5.4 years; male, 46.6%) and children from SVH (age, 6-16 years; mean ± SD, 13.1 ± 2.5 years; male, 47.8%). Prolonged P waves longer than 70 milliseconds were present in 3 (23%) of the 13 NUMC infants, whereas prolonged P waves longer than 90 milliseconds were observed in 16 (27%) of the 60 NUMC children and 7 (30%) of the 23 SVH children. Linear regression analysis revealed that age was the sole predictor of increasing P-wave durations on any lead [age = −15.33 + 0.30 (P-wave duration [milliseconds]); r 2 = 0.44]. Moreover, there was a significant increase in P-wave duration for patients aged 10 years or older, where a notable step-up in such measurements was observed. Conclusion P-wave duration is significantly associated with age among hospitalized children as well as infants, where particular increase occurs at 10 years of age or older. General pediatricians and, more importantly, pediatric cardiologists, need to be more vigilant in using appropriate age-based P-wave cutoffs when assessing interatrial conduction in this population.

Cardiopulmonary monitoring at home: the CHIME monitor

A new physiologic monitor for use in the home has been developed and used forthe Collaborative Home Infant Monitor Evaluation (CHIME). This monitormeasures infant breathing by respiratory inductance plethysmography andtransthoracic impedance; infant electrocardiogram, heart rate and R-Rinterval; haemoglobin O2 saturation of arterial blood at theperiphery and sleep position. Monitor signals from a representative sample of24 subjects from the CHIME database were of sufficient quality to beclinically interpreted 91.7% of the time for the respiratory inductanceplethysmograph, 100% for the ECG, 99.7% for the heart rate and 87% for the16 subjects of the 24 who used the pulse oximeter. The monitor detectedbreaths with a sensitivity of 96% and a specificity of 65% compared to humanscorers. It detected all clinically significant bradycardias but identified anadditional 737 events where a human scorer did not detect bradycardia. Themonitor was considered to be superior to conventional monitors and, therefore,suitable for the successful conduct of the CHIME study.

心電学研究の歴史をめぐって その４ 小児心電図研究の歴史

心電学研究の歴史をめぐって その４ 小児心電図研究の歴史

Book Reviews

NEONATAL BEHAVIOURAL ASSESSMENT SCALE, 2nd edn, edited by T. Berry Brazelton; 1984. GB: Blackwell Scientific PublicationsA PRACTICAL GUIDE TO PEDIATRIC INTENSIVE CARE, 2nd edn, edited by Daniel L. Levin, Frances C. Morriss and Gerald C. MooreTHE ELECTROCARDIOGRAM IN INFANTS AND CHILDREN: A Systematic Approach, by Arthur Garson Jr; 1983. USA: Lea & FebigerPEDIATRIC CASE STUDIES: A CLINICAL APPROACH, by M.A. Gellin and D. GeraciMANUAL OF CLINICAL PROBLEMS IN PAEDIATRICS, edited by Kenneth B. RobertsNUTRITIONAL NEEDS AND ASSESSMENT OF NORMAL GROWTH, Nestlé Nutrition Workshop Series Vol. 7, edited by Michael Gracey and Frank Falkner

The Electrocardiogram in Infants and Children

The Electrocardiogram in Infants and Children

Book ReviewThe Electrocardiogram in Infants and Children: A systematic approach

Book ReviewThe Electrocardiogram in Infants and Children: A systematic approach

A Method for Recording Electrocardiogram in Infants

A Method for Recording Electrocardiogram in Infants

The Normal and Abnormal Unipolar Electrocardiogram in Infants and Children: An Analysis of the Normal QRS Complex Morphology and Ventricular Activation. Times

The Normal and Abnormal Unipolar Electrocardiogram in Infants and Children: An Analysis of the Normal QRS Complex Morphology and Ventricular Activation. Times

The normal and abnormal unipolar electrocardiogram in infants and children. By R. H. Wasserburger, M.D. 6¾ × 9 in. Pp. 154 + ix, with 177 illustrations. 1963. London: Baillière, Tindall & Cox Ltd. 76s

The normal and abnormal unipolar electrocardiogram in infants and children. By R. H. Wasserburger, M.D. 6¾ × 9 in. Pp. 154 + ix, with 177 illustrations. 1963. London: Baillière, Tindall & Cox Ltd. 76s

The normal and abnormal unipolar electrocardiogram in infants and childrenR. H. Wasserburger

The normal and abnormal unipolar electrocardiogram in infants and childrenR. H. Wasserburger

Book Review: The Normal and Abnormal Unipolar Electrocardiogram in Infants and Children

Book Review: The Normal and Abnormal Unipolar Electrocardiogram in Infants and Children

The Normal and Abnormal Unipolar Electrocardiogram in Infants and Children

The Normal and Abnormal Unipolar Electrocardiogram in Infants and Children

The Normal and Abnormal Unipolar Electrocardiogram in Infants and Children

A rather superficial scanning of this book would probably impress the reader with the abundance of illustrative electrocardiograms and the well-conceived and informative charts of numerical data. As an atlas it probably serves a useful purpose. But as a critical study it has many serious limitations. First, it is not a study oftheelectrocardiogram at all, but only of the QRS complex, with no recognition or even reference to the great diagnostic value of the other (P and T) deflections. Second, despite the large amount of measured data on normals, there is admittedly no attempt to assess its statistical significance, or even to objectify the implication that it has any. Third, there is a significant failure to distinguish different types of hemodynamic work loads with their comparably different types of chamber enlargement. As a consequence certain limited as well as actually erroneous concepts and statements emerge. The author, for

The Normal and Abnormal Unipolar Electrocardiogram in Infants and Children. By R. H. Wasserburger, M.D., Chief of Cardiology, Veterans Administration Hospital, Associate Clinical Professor of Medicine, University of Wisconsin Medical School, Madison, Wisconsin. Pp. 150; 177 ills. Baltimore

The Normal and Abnormal Unipolar Electrocardiogram in Infants and Children. By R. H. Wasserburger, M.D., Chief of Cardiology, Veterans Administration Hospital, Associate Clinical Professor of Medicine, University of Wisconsin Medical School, Madison, Wisconsin. Pp. 150; 177 ills. Baltimore