Pediatric ECGs

A excellent description of the neonatal electrocardiogram has been made by Schwarz et al.[1][2]

Heart Axis

Normal heart axis values[3]

Age	QRS Axis Normal Values	Abnormal Values	Description
Adult	-30° to 90°	<-30° -30° to -45° -45° to -90° 90° to 120° 90° to 180°	Left-axis deviation Moderate left-axis deviation Marked left-axis deviation Moderate right-axis deviation Marked right-axis deviation
8 to 16 years	0° to 120°	>120°	Right-axis deviation
5 to 8 years	0° to 140°	>140° <0°	Right-axis deviation Left-axis deviation
1 year to 5 years	5° to 100°	>100°	Right-axis deviation
1 mo to 1 y	10° to 120°	>120° <10° to -90°	Right-axis deviation Left-axis deviation
Neonate	30° to 90°	>190° to -90° <30° to <-90°	Extreme right axis deviation Left axis deviation

Conduction

RBBB: if consistent morphology and if QRS width >90ms in children < 4 years and >100ms in children 4-16 years[3] LBBB: if consistent morphology and QRS width >90ms in children < 4 years and >100ms in children 4-16 years[3]

Normal neonatal ECG standards

Normal neonatal ECG standards

Age group	Heart rate (beats . min-1)	Frontal plane QRS axisa (degrees)	P wave amplitude (mm)	P-R intervala (s)	QRS durationa V5	Q IIIc (mm)	QV6c (mm)	RV1b (mm)	SV1b (mm)	R/S V1c	RV6b (mm)	SV6b (mm)	R/S V6c	SV1 + RV6c (mm)	R + SV4c (mm)
0–1 days	93–154 (123)	+59 to +192 (135)	2·8	0·08–0·16 (0·11)	0·02–0·08 (0·05)	5·2	1·7	5–26	0–22·5	9·8	0–11	0–9·8	10	28	52
1-3 days
3-7 days
7-30 days
1-3 months

References

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