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To Investigate the Relationship Between Prolonged QT Interval and Maternal Smoking. Research Done by: Bindu Punnoose Mentor: Dr. Michael Myers, Ph.D. Columbia Presbyterian Medical Center. Review of Literature.
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To Investigate the Relationship Between Prolonged QT Interval and Maternal Smoking Research Done by: Bindu Punnoose Mentor: Dr. Michael Myers, Ph.D. Columbia Presbyterian Medical Center
Review of Literature • Moss AJ, Schwartz PJ: Delayed Repolarization (QT or QT-U prolongation) and Malignant Ventricular Arrhythmias. Mod. Concepts Cardiovascular Dis 1982 • Schwartz PJ, Montemerio M, et al: The QT Interval Throughout the First Six Months of Life Circulation1982 • Malloy MH, Kleinman JC, Land GH, et al: The Association of Maternal Smoking With Age and Cause of Infant Death Am. J. of Epid. 1988
Review of Literature (..cont’d) • Milerad J, Sundell H: Nicotine Exposure and Risk of SIDSActa. Paediatr. Suppl. 1993 • Schwartz PJ, et al: Prolongation of the QT Interval and the Sudden Infant Death Syndrome The New England Journal of Medicine 1998
Hypothesis • A relationship exists between prolonged QT interval in infants and maternal smoking
Materials and Methods • Electrocardiograms of 24 infants (12 males 12 females) all 2 months old analyzed • 17 babies from rural Native American population • 7 babies from urban population in New York City • All infants healthy at birth with apgar scores greater than 8 • Smoking habits of mothers obtained via questionnaire given at beginning of study
Materials and Methods (..cont’d) • Babies selected by means of availability, good health, and no other risk factor (maternal alcohol consumption, low birth weight, difficult pregnancy) • ECG’s taken during baseline period of previous study were amplified and collected onto VCR tapes • Data from tapes digitized at 500 samples/sec and transformed into plottable wave forms
Materials and Methods (..cont’d) • ECG’s of each baby marked at Q, R1, R2, and T segments using special purpose software programs for 25 intervals per baby • Intervals measured in milliseconds, times recorded into SYSTAT • QT adjusted for heartrate using Bazette’s formula: QTc= (Q-T)/ (R2-R1) • Average QTc’s were found
Materials and Methods (..cont’d) • QTc’s analyzed using SYSTAT • Statistical analyses performed: t test for paired and unpaired observations • Relationships looked for between QTc interval and maternal smoking • Factors such as birth weight, sex, and maternal age also tested
Results • The mean QTc for all cases was 399+/- 26 msec • Smoking during pregnancy did not affect QTc interval • Sex and birthweight did not affect QTc interval • Maternal age affected QTc interval • Infants divided into 2 groups: • “old” mothers >25 years of age • “young” mothers <25 years of age
Results (..cont’d) • Infants with mothers classified as “young” had significantly longer QTc’s than infants with “old” mothers (t(23)=2.11, p<.05)
Discussion • As further supported by this study, QT interval of infants should be researched more thoroughly • Since prolonged QT interval is mostly thought to be genetically based and the extreme of a normal distribution, risk may be quantitatively related to length; factors affecting length could alter risk
Discussion (..cont’d) • Environmental contributions such as maternal age could give infants at risk the extra push needed for prolonged QT interval to occur • Perhaps young mothers have sub-optimal in-utero environments, making their infants prone to such a syndrome • Controversy exists as to whether ECG’s should be done on all infants. This would be costly and can have clinical implications