Measurement of the cardiac time intervals of the fetal ECG utilising a computerised algorithm: A retrospective observational study

.ObjectiveEstablish whether the reliable measurement of cardiac time intervals of the fetal ECG can be automated and to address whether this approach could be used to investigate large datasets.DesignRetrospective observational study.SettingTeaching hospitals in London UK, Nottingham UK and New York USA.ParticipantsSingleton pregnancies with no known fetal abnormality.MethodsArchived fetal ECG's performed using the MonicaAN24 monitor. A single ECG (PQRST) complex was generated from 5000 signal-averaged beats and electrical cardiac time intervals measured in an automated way and manually.Main Outcome measureValidation of a newly developed algorithm to measure the cardiac time intervals of the fetal ECG.Results188/236 (79.7%) subjects with fECGs of suitable signal:noise ratio were included for analysis comparing manual with automated measurement. PR interval was measured in 173/188 (92%), QRS complex in 170/188 (90%) and QT interval in 123/188 (65.4%). PR interval was 107.6 (12.07) ms [mean(SD)] manual vs 109.11 (14.7) ms algorithm. QRS duration was 54.72(6.35) ms manual vs 58.34(5.73) ms algorithm. QT-interval was 268.93 (21.59) ms manual vs 261.63 (36.16) ms algorithm. QTc was 407.5(32.71) ms manual vs 396.4 (54.78) ms algorithm. The QRS-duration increased with gestational age in both manual and algorithm measurements.ConclusionAccurate measurement of fetal ECG cardiac time intervals can be automated with potential application to interpretation of larger datasets

Hepatic hemangioendothelioma presenting as sudden unexpected death in infancy: A case report

The classification of an unexpected infant death as suddeninfant death syndrome (SIDS) depends upon a complete autopsy, death scene investigation, and review of medical history to exclude known causes of death. Death from occult neoplastic disease in infancy is extremely rare but is within the broad differential diagnosis of SIDS. We report the sudden and unexpected death of a 1-month-old infant from a hepatic (infantile) hemangioendothelioma. The physiologic mechanism of death was likely cardiac failure induced by the circulatory demands of this large vascular tumor and respiratory compromise from diaphragmatic thoracic incursion. The clinical progression and pathology of these relatively common tumors of infant livers are extremely variable. This case dramatically illustrates the potential for fatal outcome of this tumor, as well as the need for autopsy to determine the cause of sudden and unexpected death in an infant. © 2011 Society for Pediatric Pathology.Articl