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A total of 305 infants presenting with apparent life-threatening events (ALE) were referred by their paediatricians and underwent 24-hour tape recordings of electrocardiogram and abdominal breathing movements (from a pressure capsule transducer). Seventy-seven of these infants, all full-term (greater than or equal to 37 weeks of gestation), were randomly selected, followed up for clinical outcome, and their recordings subjected to a detailed analysis of heart and respiratory rates and breathing patterns. Recordings on 157 age-matched, full-term controls were similarly analysed for comparison purposes. One of the 77 patients suffering from ALE had a pre-existing neurodevelopmental problem, and 4 more cases showed this at follow-up, including 1 case whose ALE was subsequently diagnosed as originating from non-accidental injury. Compared with controls and as a group, the patients suffering from ALE showed higher numbers of apnoeic pauses (p less than 0.001), larger quantities of periodic breathing (p less than 0.01) and lower respiratory rates during regular breathing (p less than 0.01).

Among 818 newborn babies whose electrocardiograms (ECGs) were recorded between April 1975 and April 1976 were 57 babies with recordings that fell outside the accepted normal range. Preliminary observations have identified the need to define more clearly the range of normal variation. Twelve babies showed asymptomatic conduction abnormalities, three of which were thought sufficiently serious to need treatment. Two babies died suddenly, one of whom had abnormal conduction on the ECG and histologically demonstrated abnormalities of the conducting system. This continuing prospective study may indicate a link between conducting tissue abnormalities and the sudden infant death syndrome. Ten babies had congenital cardiac anomalies, four of which were first discovered because of an abnormal screening cardiogram. Electrocardiography, a simple and noninvasive procedure, may be a valuable addition to the routine neonatal examination.

Standard electrocardiogram recordings were performed on a total of 7254 newly born infants from two maternity hospitals. Fifteen recordings were obtained on 15 infants who subsequently suffered sudden infant death syndrome. None showed lengthening of QT intervals sufficient to warrant the description of 'long QT syndrome'. When the QT intervals corrected for heart rate of cases with sudden infant death syndrome were compared with controls in age matched groups or after individual matching for postnatal age, hospital of birth, and weight at birth, no significant differences could be identified.

Two neonates with arrhythmias and the long QT syndrome are described. The arrhythmias were detected in utero and both infants were apparently well after birth. The first infant, although well, had a bradycardia for the first 9 days of life. A normal heart rate was documented at 10 days but a prolonged QT interval was not appreciated on the ECG. He was discharged from hospital but died suddenly and unexpectedly 3 days later. A post-mortem examination failed to find a cause for his death which therefore fell into the category of the sudden infant death syndrome (SIDS). A retrospective analysis of the perinatal electrocardiogram showed a probable junctional rhythm with 2:1 conduction to the ventricle; the QT interval was prolonged at 0.52 seconds (QTC = 0.63). The second infant had a QT interval of 0.52 seconds (QTC = 0.54) and frequent ventricular premature beats on a 24-hour electrocardiogram. She was treated with propranolol and remains well 2 years later. Sudden infant death has often been described in the siblings of children with the long QT syndrome and one other report described a case of SIDS which was said to have had a prolonged QT interval on the perinatal ECG. This report, however, provides unquestionable evidence, in one case, of an association between the long QT syndrome and SIDS.

Twenty-four-hour tape recordings of ECG and breathing movements from 16 term infants (greater than or equal to 37 weeks' gestation) who subsequently died of sudden infant death syndrome (SIDS) were compared with recordings from surviving infants from the same populations. Apneic pauses of varying durations, periodic and regular breathing patterns, heart and respiratory rates during regular breathing were measured. Only one of 16 full-term infants with SIDS had findings outside the range of age-matched control infants (an excess of periodic breathing patterns and an absence of regular breathing). When the first recordings of each of infants who died of SIDS, except one who had cyanotic episodes prior to death, were compared to recordings of survivors (six for each case) closely matched for age, gestation, and weight at birth, no differences in breathing patterns or heart or respiratory rates during regular breathing could be demonstrated. These particular measurements of cardiorespiratory function were, therefore, unable to identify the majority of full-term infants at risk for SIDS.

The quantities of sinus tachycardia in 24-h recordings of the electrocardiogram from 16 full-term infants (greater than or equal to 37 weeks gestation) who were subsequently victims of the sudden infant death syndrome (SIDS), from 230 randomly selected age-matched full-term survivors and from 64 full-term survivors matched for age and birth weight were measured by computer and manual analysis techniques. Of 16 infants dying of SIDS, 7 had elevated levels of sinus tachycardia (greater than 95th centile in controls) (P less than 0.01). Although high levels of sinus tachycardia might be of value in identifying infants at high risk of SIDS, these encouraging findings must first be validated by further prospective studies. [ABSTRACT FROM AUTHOR]

A mother and three children presenting with syncope induced by exercise and emotion were diagnosed as epileptic. They, and three symptom free children, showed frequent ventricular and supraventricular tachyarrhythmias on ambulatory electrocardiographic monitoring. Three died before the correct diagnosis of disordered sympathetic innervation of the heart was made, but episodes of syncope and cardiac arrhythmias in the survivors have been successfully treated by propranolol. [ABSTRACT FROM AUTHOR]