medigraphic.com
ISSN 2007-2783 (Print)
Órgano Oficial del Instituto Científico Pfizer

2011, Number 3

<< Back

Residente 2011; 6 (3)

Utilidad del electrocardiograma en el diagnóstico de cardiopatías congénitas del neonato

Solano FL, Sánchez UR, Arévalo SLA, Romero RJA, Reyes GME, Sierra RJosé-Alfredo

Language: Spanish
References: 23
Page: 165-172
PDF size: 82.19 Kb.


ABSTRACT

Background: The electrocardiographic recording of the heart is a noninvasive procedure that allows the diagnostic of congenital heart diseases. The aim of this study was to evaluate the efficacy of the electrocardiogram (ECG) in the detection of heart diseases in the neonatal period. Methods: An ambispective, randomized, multicenter study was designed which included 325 healthy or with congenital heart disease male or female infants. A blinded interpretation of the ECG was performed by an expert (pediatric cardiologist) and diagnostic accuracy was compared with echocardiography. Results: The average age in the first evaluation of the neonate was 13.9 ± 10.2 days; 19.5% were premature, 0.5% were post-term and 80% were at term. Congenital heart diseases were identified in 204 of 325 neonates (63%). ECG alone identified congenital heart diseases with a sensitivity of 72.6% (95% CI 66.2-78.9), specificity of 71.1% (95% CI 62.6-79.6), positive predictive value of 80.9% (95% CI 74.9-86.9) and negative predictive value of 60.6% (95% CI 52.2-69.0). ECG increase detection of complex heart diseases with a sensitivity of 89.7% (95% CI 83.5-95.9), specificity of 98.6% (95% CI 96.9-100.0), positive predictive value of 97.0% (95% CI 93.1-100.0) and negative predictive value of 95.1% (95% CI 92.1-98.2). Conclusions: ECG assessment detected congenital heart diseases in neonates with acceptable efficacy, its usefulness increases in serious and complex heart diseases.


REFERENCES

  1. Perloff JK. The recognition of congenital heart disease. Saunders 2003. Fith edition. Chapter 1.

  2. Allen HD, Driscoll DJ, Moss and Adams. Heart disease in infants, children and adolescents, including the fetus and young adults. 7th Edition. 2008. Lippincott Williams & Wilkins.

  3. Wren C, Richmond S, Donaldson L. Temporal variability in birth prevalence of cardiovascular malformations. Heart 2000; 83: 414-19.

  4. Secretaría General del Consejo Nacional de Población. Principales causas de mortalidad en México 1980-2007. Documento de Trabajo para el XLIII Periodo de Sesiones de la Comisión de Población y Desarrollo “Salud, morbilidad, mortalidad y desarrollo”.

  5. Secretaría de Salud/Dirección General de Información en Salud. Información estadística en México del año 2008. http://www.inegi.gob.mx/est/contenidos/ espanol/rutinas/ept.asp

  6. Pearlman AS, Ryan T, Picard M, Douglas PS. Evolving trends in the use of echocardiography: A study of medicare beneficiaries. J Am Coll Cardiol 2007; 49; 2283-91.

  7. Yi, Kimball TR, Tsevat J, Mrus JM, Kotagal UR. Evaluation of heart murmurs in children: Cost-effectiveness and practical implications. J Pediatr 2002; 141: 504-11.

  8. Wren C, Richmond S, Donaldson L. Presentation of congenital heart disease in infancy: implications for routine examination. Arch Dis Child Fetal Neonatal Ed 1999; 80: F49-53.

  9. Knowles R, Griebsch I, Dezateux C, Brown J, Bull C, Wren C. Newborn screening for congenital heart defects: a systematic review and cost-effectiveness analysis. Health Technology Assessment 2005; 9(44): 37-45.

  10. Schwartz PJ, Garson A Jr, Stramba-Badiale M PT, Vetter VL, Villian E, Wren C. Guidelines for the interpretation of the neonatal electrocardiogram. A Task Force of the European Society of Cardiology. Eur Heart J 2002; 23: 1329-1344.

  11. Davignon A, Rautaharju P, Boiselle E, Soumis F, Megelas M, Choquette A. Normal ECG standards for infants and children. Pediatr Cardiol 1979; 1: 123-52.

  12. Romero-Rivera I, Mendonça-da Silva MA, Gonçalves-Fernandes JM, Pimenteira-Thomaz AC. Congenital heart diseases in the newborn: from the pediatrician’s request to the cardiologist’s evaluation. Arq Bras Cardiol 2007; 89: 6-10.

  13. Steinhorn RH. Evaluation and management of the cyanotic neonate. Clin Ped Emerg Med 2008; 9: 169-175.

  14. Maroto-Monedero C, Camino-López M, Girona-Comas JM, Malo-Concepción P. Guías de práctica clínica de la Sociedad Española de Cardiología en las cardiopatías congénitas del recién nacido. Rev Esp Cardiol 2001; 54: 49-66.

  15. Park MK, Warren GG. El electrocardiograma pediátrico. 3ª Ed. 1994. Ed Mosby.

  16. Kligfield P. The centennial of the Einthoven electrocardiogram. J Electrocardiol 2002; 35 Suppl: 123-9.

  17. Mackie AS, Jutras LC, Dancea AB, Rohlicek CV, Platt R, Béland MJ. Can cardiologist distinguish innocent from pathologic murmurs in neonates? J Pediatr 2009; 154: 50-4.

  18. Gardiner S. Are routine chest x ray and ECG examinations helpful in the evaluation of asymptomatic heart murmurs? Arch Dis Child 2003; 88: 638-642.

  19. Rajakumar K, Weisse M, Rosas A et al. Comparative study of clinical evaluation of heart murmurs by general pediatricians and pediatric cardiologists. Clin Pediatr (Phila) 1999; 38: 511-18.

  20. Danford DA, Gumbiner CH, Martin AB, Fletcher SE. Effects of electrocardiography and chest radiography on the accuracy of preliminary diagnosis of common congenital cardiac defects. Pediatr Cardiol 2000; 21: 334-340.

  21. O’Connor M, McDaniel N, Brady WJ. The pediatric electrocardiogram part III: Congenital heart disease and other cardiac syndromes. Am J Emerg Med 2008; 26(4): 497-503.

  22. Quaglini S, Rognoni C, Spazzolini C, Priori SG, Mannarino S, Schartz PJ. Cost-effectiveness of neontal ECG screening for the long QT sindrome. Eur Heart J 2006; 27(15): 1824-32.

  23. Cruz-Cañete M, Rus Mansilla C, Gómez-Lara A, Gavilán-Expósito ML, Calleja-Cabezas P, Gavilán-Pérez M. Utilidad del cribado electrocardiográfico en población neonatal. An Pediatr (Barc) 2011; 74(5); 303-8.




2020     |     www.medigraphic.com