Effects of umbilical venous catheters on arrhythmia and heart rate variability in premature newborns

Abstract

Aim: Cardiac rhythm abnormalities associated with umbilical venous catheters in newborns are limited to anecdotal case reports The present study intended to evaluate association between umbilical venous catheter arrhythmic potential and changes in heart rate variability Material and Method: The study consisted of two groups; 26 preterm newborns with a umbilical venous catheter group 1 and 26 control group without group 2 The following parameters were recorded prospectively: gender gestation at birth birth weight and clinical assessment scores SNAP II and SNAPPE II Holter recordings were fitted in all newborns The heart rate variability study was performed by utilizing time domain and frequency domain analyses Results: The study population consisted of group 1 30 63 plusmn;2 67 weeks of gestation and group 2 31 60 plusmn;2 45 weeks of gestation There was no statistical difference between the two groups for gestational age birth weight SNAP II and SNAPPE II scores When compared for arrhythmia there was no statistical difference in any parameters between the two study groups Premature atrial contraction was noted in 11 babies 42 3 in group 1 and in 7 babies 26 9 in group 2 Premature ventricular contraction was noted in 3 babies 11 5 in group 1 and in one baby in group 2 Sinus tachycardia detected in 3 patients in only the group 1 None of the heart rate variability parameters were found to be statistically different between the two groups Conclusions: Our study reassuringly demonstrated that umbilical venous catheter does not have any significant effect on arrhythmia or heart rate variability in preterm newborns Turk Arch Ped 2013; 48: 131 7

Keywords

• Arrhythmia, heart rate variability, newborn

Erken doğmuş bebeklerde göbek ven kateterinin aritmi ve kalp hızı değişkenliği üzerine etkileri

Abstract

Amaç: Yenidoğanlarda göbek veni kateterizasyonu ile ilişkili ritm bozuklukları olgu sunumları ile sınırlıdır Bu çalışma erken doğmuş bebeklerde göbek ven kateterizasyonunun aritmi ve kalp hızı değişkenliği üzerindeki etkisini araştırmak amacıyla yapılmıştır. 

Gereç ve Yöntem: Çalışma erken doğmuş bebeklerden oluşan iki grupta yapılmıştır Grup I: Göbek ven kateteri takılı olan 26 bebek; grup II: göbek ven kateteri takılı olmayan 26 bebekten oluşmaktadır Bütün bebeklerin cinsiyet doğum haftası doğum kilosu ve klinik değerlendirme puanları SNAP II ve SNAPPE II kaydedildi Bebeklerin hepsine 24 saatlik Holter elektrokardiyografi takıldı Kalp hızı değişkenliği zaman alanlı ve frekans alanlı değişkenler kullanılarak çalışıldı.

Bulgular: Çalışmaya alınan bebeklerin ortalama doğum haftası grup 1 rsquo;de 30 63 plusmn;2 67 grup 2 rsquo;de ise 31 60 plusmn;2 45 idi Gruplar arasında doğum haftası doğum ağırlığı SNAP II ve SNAPPE II puanları arasında istatistiksel olarak anlamlı fark saptanmadı Aritmi açısından karşılaştırıldığında iki grup arasında istatistiksel olarak fark bulunmadı Atriyal erken vuru grup 1 rsquo;de 11 hastada 42 3 grup 2 rsquo;de 7 hastada 26 9 saptandı Ventriküler erken vuru grup 1 rsquo;de 3 hastada 11 5 grup 2 rsquo;de bir hastada saptandı Sinüs taşikardisi ise sadece grup 1 rsquo;de yer alan üç hastada bulundu Kalp hızı değişkenliği iki grup arasında istatistiksel olarak farklı bulunmadı.

Çıkarımlar: Çalışmamızda göbek ven kateterinin erken doğmuş yenidoğanlar da aritmi veya kalp hızı değişkenliği üzerinde anlamlı bir etkisinin olmadığı gösterilmiştir.

Keywords

• Aritmi
• kalp hızı değişkenliği
• yenidoğan

References

1. Ginsberg HG. Advantages of dual-lumen umbilical vessel catheters versus single-lumen umbilical vessel catheters and additional peripheral intravenous catheters. J Perinatol 1997; 17(3): 218-20.
2. Green C, Yohannan MD. Umbilical arterial and venous catheters: placement, use, and complications. Neonatal Netw 1998; 17(6): 23Jackson JK, Biondo DJ, Jones JM, et al. Can an alternative umbilical arterial catheter solution and flush regimen decrease iatrogenic hemolysis while enhancing nutrition? A double-blind, randomized, clinical trial comparing an isotonic amino acid with a hypotonic salt infusion. Pediatrics 2004; 114(2): 377-83.
3. Ramachandran P, Cohen RS, Kim EH, Glasscock GF. Experience with double-lumen umbilical venous catheters in the low-birthweight neonate. J Perinatol 1994; 14(4): 280-4.
4. Tiffany KF, Burke BL, Collins-Odoms C, Oelberg DG. Current practice regarding the enteral feeding of high-risk newborns with umbilical catheters in situ. Pediatrics 2003; 112(1): 20-3.
5. Beardsall K, White DK, Pinto EM, Kelsall AW. Pericardial effusion and cardiac tamponade as complications of neonatal long lines: are they really a problem? Arch Dis Child Fetal Neonatal Ed 2003; 88(4): 292-5.
6. Daniels SR, Hannon DW, Meyer RA, Kaplan S. Paroxysmal supraventricular tachycardia. A complication of jugular central venous catheters in neonates. Am J Dis Child 1984; 138(5): 474-5. Onal EE, Saygili A, Koç E, Türkyilmaz C, Okumus N, Atalay Y. Cardiac tamponade in a newborn because of umbilical venous catheterization: is correct position safe? Paediatr Anaesth 2004; 14(11): 953-6.
7. Purohit DM, Levkoff AM. Pericardial effusion complicating umbilical venous catheterization. Arch Dis Child 1977; 52: 520.
8. Raval NC, Gonzalez E, Bhat AM, Pearlman SA, Stefano JL. Umbilical venous catheters: evaluation of radiographs to determine position and associated complications of malpositioned umbilical venous catheters. Am J Perinatol 1995; 12(3): 201-4.

9. Salvadori S, Piva D, Filippone M. Umbilical venous line displacement as a consequence of abdominal girth variation. J Pediatr 2002; 141(5): 737.
10. Scott JM. Iatrogenic lesions in babies followıng umbilical vein catheterization. Arch Dis Child 1965; 40: 426-9.
11. Sehgal A, Cook V, Dunn M. Pericardial effusion associated with an appropriately placed umbilical venous catheter. J Perinatol 2007; 27(5): 317-9.
12. Cephus CE, Mott AR, Kertesz NJ, Slesnick TC. Transient complete atrioventricular block after placement of a central venous catheter in a neonate. Pediatr Crit Care Med 2007; 8(1): 64-6.
13. Sinha A, Fernandes CJ, Kim JJ, Fenrich AL Jr, Enciso J. Atrial flutter following placement of an umbilical venous catheter. Am J Perinatol 2005; 22(5): 275-7.
14. Shukla H, Ferrara A. Rapid estimation of insertional length of umbilical catheters in newborns. Am J Dis Child 1986; 140(8): 786Richardson DK, Corcoran JD, Escobar GJ, Lee SK SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores. J Pediatr 2001; 138(1): 92-100.
15. No authors listed. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 1996; 93(5): 1043–65.
16. Leroy V, Belin V, Farnoux C, et al. A case of atrial flutter after umbilical venous catheterization. Arch Pediatr 2002; 9(2): 147-50. Fiaccadori E, Gonzi G, Zambrelli P, Tortorella G. Cardiac arrhythmias during central venous catheter procedures in acute renal failure: a prospective study. J Am Soc Nephrol 1996; 7(7): 1079Yilmazlar A, Bilgin H, Korfali G, Eren A, Ozkan U. Complications of 1303 central venous cannulations. J R Soc Med 1997; 90(6): 319-21.
17. Luesink M, Smeets JL, Brons PP, Kapusta L. An unusual cause of atrial tachycardia in a young patient with lymphoma. Clin Pediatr (Phila) 2009; 48(4): 449-50.
18. Oyston JP, Burrows FA, Lerman J. Factors influencing the R-R interval during central venous injection in newborn swine. Can J Anaesth 1989; 36(5): 554-9.
19. Kurowski V, Fink C, Schwieder G, Djonlagic H. Arrhythmia caused by a too rapid central venous administration of cefotaxime. Dtsch Med Wochenschr 1993; 118(4): 1502-3.
20. Badrawi N, Hegazy RA, Tokovic E, Lotfy W, Mahmoud F, Aly H. Arrhythmia in the neonatal intensive care unit. Pediatr Cardiol 2009; 30(3): 325-30.
21. Khattak AZ, Padhye NS, Williams AL, Lasky RE, Moya FR, Verklan MT. Longitudinal assessment of heart rate variability in very low birth weight infants during their NICU stay. Early Hum Dev 2007; 83(6): 361-6.
22. Mehta SK, Super DM, Connuck D, et al. Heart rate variability in healthy newborn infants. Am J Cardiol 2002; 89(1): 50-3.
23. Montague TJ, Taylor PG, Stockton R, Roy DL, Smith ER. The spectrum of cardiac rate and rhythm in normal newborns. Pediatr Cardiol 1982; 2(1): 33- 8.
24. Pandolfi M, Falsini G, Lazzerini S, et al. ECG monitoring in fullterm infants. Analysis of the rhythm and variability of heart rate. Pediatr Med Chir 1993; 15(6): 569-71.
25. Clairambault J, Curzi-Dascalova L, Kauffmann F, Médigue C, Leffler C. Heart rate variability in normal sleeping full-term and preterm neonates. Early Hum Dev 1992; 28(2): 169-83.
26. Doussard-Rossevelt J, Porges SW, McClenny BD. Behavioral sleep states in very low birth weight preterm neonates: relation to neonatal health and vagal maturation. J Pediatr Psychol 1996; 21(6): 785-802.
27. Fox NA, Porges SW. The relation between neonatal heart period patterns and developmental outcome. Child Dev 1985; 56(1): 28
28. Groome LJ, Loizou PC, Holland SB, Smith LA, Hoff C. High vagal tone is associated with more efficient regulation of homeostasis in low-risk human fetuses. Dev Psychobiol 1999; 35(1): 25-34.
29. Makarov L, Komoliatova V, Zevald S, Schmidt G, Muller CA, Serebruany V. QT dynamicity, microvolt T-wave alternans, and heart rate variability during 24-hour ambulatory electrocardiogram monitoring in the healthy newborn of first to fourth day of life. J Electrocardiol 2010; 43(1): 8-14.