Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy.
Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Ospedali Riuniti, Ancona, Italy.
Ann Noninvasive Electrocardiol. 2020 Jul;25(4):e12745. doi: 10.1111/anec.12745. Epub 2020 Jan 27.
Sudden infant death syndrome is more frequent in preterm infants (PTI) than term infants and may be due to cardiac repolarization instability, which may manifest as T-wave alternans (TWA) on the electrocardiogram (ECG). Therefore, the aim of the present work was to analyze TWA in nonpathological PTI and to open an issue on its physiological interpretation.
Clinical population consisted of ten nonpathological PTI (gestational age ranging from 29 to 34 weeks; birth weight ranging from 0.84 to 2.10 kg) from whom ECG recordings were obtained ("Preterm infant cardio-respiratory signals database" by Physionet). TWA was identified through the heart-rate adapting match filter method and characterized in terms of mean amplitude values (TWAA). TWA correlation with several other clinical and ECG features, among which gestational age-birth weight ratio, RR interval, heart-rate variability, and QT interval, was also performed.
TWA was variable among infants (TWAA = 26 ± 11 µV). Significant correlations were found between TWAA versus birth weight (ρ = -0.72, p = .02), TWAA versus gestational age-birth weight ratio (ρ = 0.76, p = .02) and TWAA versus heart-rate variability (ρ = -0.71, p = .02).
Our preliminary retrospective study suggests that nonpathological PTI show TWA of few tens of µV, the interpretation of which is still an open issue but could indicate a condition of cardiac risk possibly related to the low development status of the infant. Further investigations are needed to solve this issue.
早产儿（PTI）中婴儿猝死综合征的发生率高于足月儿，这可能是由于心脏复极不稳定，表现在心电图（ECG）上可能是 T 波交替（TWA）。因此，本研究旨在分析非病理 PTI 中的 TWA，并对其生理解释提出问题。
临床人群包括 10 名非病理 PTI（胎龄 29 至 34 周；出生体重 0.84 至 2.10kg），从这些婴儿中获得 ECG 记录（Physionet 的“早产儿心肺信号数据库”）。TWA 通过心率自适应匹配滤波器方法识别，并以平均振幅值（TWAA）进行特征描述。还对 TWA 与其他几个临床和 ECG 特征（包括胎龄-出生体重比、RR 间期、心率变异性和 QT 间期）的相关性进行了分析。
TWA 在婴儿之间存在差异（TWAA=26±11µV）。TWAA 与出生体重（ρ=-0.72，p=0.02）、TWAA 与胎龄-出生体重比（ρ=0.76，p=0.02）和 TWAA 与心率变异性（ρ=-0.71，p=0.02）之间存在显著相关性。
我们的初步回顾性研究表明，非病理 PTI 表现出数十 µV 的 TWA，其解释仍然是一个悬而未决的问题，但可能表明婴儿心脏风险的状况，可能与婴儿的低发育状态有关。需要进一步的研究来解决这个问题。
