A Guide to Neonatal and Pediatric ECGs – This manual is meant for cardiologists, pediatricians, neonatologists, pediatric cardiac surgeons, emergency medicine physicians, nursing personnel, medical students and residents who possess the basic knowledge to read an ECG and need to know the specific procedures to apply to pediatrics.
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A Guide to Neonatal and Pediatric ECGs -This manual provides a highly simplified method for pediatric ECG analysis. It requires observing only a few elements but allows for the immediate recognition of a pathological condition. Part I delineates the ECG reading method to follow, as well as describing normal pediatric ECG parameters. Part II provides a description of pathological scenarios specific to pediatrics. Finally, in Part III, the manual provides the most common applications for pediatric ECGs.
The pediatric ECG reading method is based on the fact that the morphology of a normal ECG varies with age. The electrical activity of the heart reflects hemodynamic cardiac changes, which are at their height in the first month of life and which continue, in part, through the first year of life and beyond.
The general guideline is: a normal pediatric ECG is one in which the morphology is congruous with the age of the young patient. Attention must be paid to the morphology of ventricular depolarization (the QRS complex) and of ventricular repolarization (the T wave). The morphology of these two elements, which change mainly during the first few months of life, should be in accordance with the age of the patient.
Three patterns can be distinguished through the morphology of the QRS complex and the T wave:
• The neonatal pattern.
• The infant pattern.
• The adult pattern.
The neonatal pattern ECG is typical in the first month of life. In a normal subject, this changes after the first month and takes on the characteristics of the infant pattern, which can last up to the age of three. After this point, it changes again, taking on the characteristics of the adult pattern.
Normally, the ECG pattern is in line with the age of the patient. Finding an ECG pattern that is incongruous with the patient’s age, for example a neonatal pattern after the first month of life, leads to the conclusion that there is pathological reason. Thus, a series of ECGs conducted on the same patient over time can be very useful to pinpoint the emergence of pathological signs.
It is useful to specify that the terms “newborn” and “infant” are not equivalent to the “neonatal” and “infant” ECG patterns. There is a temporal correspondence between a “newborn”, i.e. a child in the first month of life, and a “neonatal ECG pattern”, which occurs only in the first month of life for normal subjects. This is not the case, however, for the term “infant”, referring to a child in the first year of life, and the term “infant ECG pattern”, which can occur at birth and last until the age of three