Consequences of electrocardiography screening for prolonged QTc in neonates - A systematic review.

Abstract

Background: An ongoing discussion has been the effectiveness of neonatal ECG screening for long QT syndrome (LQTS).

Objective: T0 assess the consequences of ECG screening for prolonged corrected QT (QTc) interval in infants under one month of age.

Methods: We searched the PubMed, Scopus, and Web of Science databases in June 2024. The incidence rates of prolonged QTc, defined as >450ms, were calculated per 1,000 neonates. Prolonged QTc cases, including normalization during follow-up, LQTS diagnosis, or sudden infant death syndrome (SIDS), were analyzed.

Results: Eight studies were included. Five studies using a cutoff QTc >450ms reported incidences ranging from five (95 % confidence interval (CI: 5-6) to 79 (CI: 60-102) per 1,000 neonates. Six studies with a cutoff of >460ms reported incidences ranging from one (CI: 1-2) to 53 (CI: 50-57). Five studies (cutoff QTc >470ms) had incidences varying from 1 (CI 0-1) to 28 (CI 21-35). In six studies, QTc normalization during follow-up occurred in 57.1% to 95.2% of neonates with prolonged QTc. The diagnosis of LQTS was reported in four studies, with 21 out of 51,817 (0.04%) neonates later diagnosed with LQTS. Two studies reported SIDS outcomes, finding prolonged QTc in 8/24 and 3/3 of SIDS cases.

Conclusion: The incidence of prolonged QTc varied widely across studies. Only a small proportion of neonates with prolonged QTc were diagnosed with LQTS during follow-up. Further research with standardized study factors and comprehensive genetic analysis is needed to determine the utility of and indications for neonatal ECG screening.