ArticleEuropean journal of pediatrics2026
Postnatal evolution of electrocardiographic parameters in preterm infants: a prospective longitudinal cohort study.
Article in European journal of pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Electrocardiography (ECG), an indispensable bedside tool in neonatal intensive care, complements echocardiography by providing assessment of cardiac rhythm and conduction, and when advanced imaging is unavailable, serves as a screening tool. Preterm birth alters cardiac and autonomic maturation. Applying term-based ECG norms may misclassify physiological findings in preterm. We aimed to characterise serial ECG maturation in preterms from birth to term-equivalent age and define gestational- and postnatal-age-specific patterns relevant to clinical interpretation. In this prospective cohort, infants between 28⁰/₇ and 36⁶/₇ weeks' gestation without congenital heart disease underwent serial 11-lead ECG recording within 24 h of birth, on day 7, day 28 and at term-equivalent age. Postnatal and gestation-based differences in ECG parameters were analysed and centile charts were generated. Among 249 infants (mean gestation-33
conclusionPreterm ECG findings are dynamic, gestation-dependent markers of cardiovascular transition. This study characterises longitudinal ECG maturation in preterms and provides reference values, supporting improved decision-making in preterm care. WHAT IS KNOWN: • Electrocardiographic reference nomograms used in neonatal practice are primarily based on paediatric cohorts or cross-sectional studies of term infants. These references provide limited information on longitudinal electrophysiologic maturation in preterm neonates. WHAT IS NEW: • In a cohort of 249 preterm infants, serial ECG measurements demonstrated changes in axes, QTc, and precordial voltages from birth to term-equivalent age. • These gestation and age-specific trajectories support cautious interpretation of preterm ECGs using term-derived standards.
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