1. The lack of association of ST-T wave abnormalities to significant heart disease in asymptomatic neonates Sudheer R Gorla, MD 1, Daphne T Hsu, MD 2 and Aparna Kulkarni, MD 1,2 Bronx Lebanon Hospital Center 1, Albert Einstein College of Medicine 2, Bronx, NY All authors have no disclosures to make. ST- T wave abnormalities (ST-TWA) have been described in 20% of electrocardiograms (ECGs) in neonates. There is no existing evidence regarding the association of ST- TWA to perinatal factors and congenital heart disease (CHD). Evaluate relationship of ST-TWA to CHD Explore associations of perinatal risk factors to isolated ST-TWA. Number of ECGSs screened = 1043 Number ECGS that met inclusion criteria = 664 ST-TWA = 236/664 subjects (35.5%) Retrospective chart review from Jan 2008- March 2013 Inclusion Criteria: Neonates >37 weeks of gestation and ECG in first 3 days after birth Exclusion Criteria: Critical CHD, oxygen saturation <90%in room air, arrhythmias, axis abnormalities on ECG ECGs were confirmed by board certified pediatric cardiologists prior to the study. ECGs were reviewed for STTWA : elevated or depressed ST segment by >2mm in at least one lead, flat or inverted T wave in at least one lead except aVR. Medical Records were reviewed for outcomes of neonates for CHD and perinatal risk factors. Comparisons were made for statistical analysis between subjects with and without ST-TWA using chi-square or Fisher’s exact test. ST-TWA are commonly seen in one third (35.5%) of ECGs in asymptomatic neonates. ST-TWA do not predict CHD. No relationship was found of ST-TWA to perinatal risk factors. Extensive cardiology evaluation may not be required in asymptomatic neonates with ST-TWA and an otherwise normal ECG. Fig 2: Association of ST-TWA to CHD Background: Objectives: Methods: Fig 1: Incidence of STTW changes Table 1: Association between STTW changes and perinatal risk factors Results: Summary: VariableNo ST abnormalities n=587 ST abnormalities n=77 No T wave abnormality n=473 T wave abnormality n=191 Preeclampsia49 (8.4)9 (11.7)38 (8.0)20 (10.5) Diabetes Mellitus 41 (6.9)7 (9.1)33 (6.9)15 (7.9) Thyroid Disorder 9 (1.5)1 (1.3)5 (1.1)5 (2.6) Maternal Seizures 5 (0.9)1 (1.3)4 (0.8)2 (1.0) Magnesium41 (6.9)9 (11.7)35 (7.4)15 (7.9) Oxytocin93 (15.8)14 (18.2)78 (16.5)29 (15.2) Morphine43 (7.3)7 (9.1)39 (8.2)11 (5.8) Penicillin G104 (17.7)12 (15.6)77 (16.3)39 (20.4) Cefazolin97 (16.5)5 (6.5)79 (16.7)23 (12.0) Spinal Anesthesia 119 (20.3)16 (20.8)101 (21.4)34 (17.8) General Anesthesia 4 (0.7)1 (1.3)3 (0.6)2 (1.0) Epidural Anesthesia 231 (39.3)26 (33.7)183 (38.6)74 (38.7) NSVD376 (64.1)50 (64.9)299 (63.2)127 (66.5) C- section210 (35.8)27 (35.1)173 (36.6)64 (33.5) Assisted labor21 (3.6)2 (2.6)17 (3.6)6 (3.1) APGAR score 5 min < 7 5 (0.9)0 (0)5 (1.1)1 (0.5) Oxygen by nasal cannula 1 (0.2)0 (0)1 (0.2)0 (0) NCPAP14 (2.4)1 (1.3)10 (2.1)5 (2.6) SIMV2 (0.3)0 (0)2 (0.4)0 (0) 11.6%28.7% 4.8% CHD was detected in 59/84 subjects (8.9%): 17 (28.8%) in pts. with ST-TWA and 42 (71.2%) in pts. without STTWA. Forms of CHD – VSD (29, 49.1%), ASD (17, 28.8%), PS (4, 6.8%), mild coarctation of aorta (3, 5.1%), bicuspid aortic valve (2, 3.4%), scimitar syndrome (1, 1.7%), bilateral superior vena cavae (1,1.7%), tricuspid valve dysplasia (1,1.7%) No association was found between ST-TWA and perinatal risk factors, except weak association of ST changes to maternal cefazolin administration (p=0.03).