Electrocardiographic Signs of Myocardial Depolarization Disorders in Newborns Conceived by in Vitro Fertilization and the Possibilities of its Management

Background. Recently, a significant increase in the use of Ancillary Assisted Reproductive Technologies (ART) is noted. Meanwhile, the electrophysiological state of the myocardium, including the risk of cardiac rhythm disorders (CRD), in newborns after in vitro fertilization (IVF) remains poorly understood. No comprehensive assessments of the parameters of a standard electrocardiogram (ECG) is available, as well as approaches to their treatment in the early neonatal period in this category of patients.

Objective. The aim of the study is to research the electrocardiographic effects of myocardial depolarization disorders in newborns conceived with IVF and to evaluate the effectiveness of Cytoflavin in treatment of the detected disorders in premature infants with cerebral ischemia (CI).

Methods. The study design included 2 stages. At the first stage, a single-center, nonconcurrent, cross-sectional comparative cohort study was conducted, which included 580 newborns divided into 2 groups: the main group (children after IVF, n = 206) and the comparison group (children from spontaneous pregnancy, n = 374). The groups were stratified by fetal age (35–37 and 38-40 weeks), and the presence of CI, grade I–II. On the 3rd day of life, all children underwent a standard ECG with an analysis of rhythm parameters, conduction, and markers of depolarization disorders. At the second stage, an open comparative randomized study of the efficacy of Cytoflavin (2 ml/kg/day) was conducted in 60 premature infants with CI. The dynamics of rhythm disturbances was assessed on the 5th day after therapy.

Results. Atrial rhythm (8.3% vs. 2.5%, p = 0.003) and supraventricular extrasystole (15.5% vs. 7.4%, p = 0.004) were more frequently reported in newborns conceived by IVF. Specific changes in depolarization parameters have been identified: a decrease in the amplitude and duration of the P wave, a shortening of the PQ interval, and an elongation of the QRS complex. The most pronounced violations of intraventricular conduction were observed in premature infants with СI of the main group. Multifactorial analysis confirmed that the method of conception (IVF) is an independent risk factor for depolarization disorders (OR = 1.58; 95% CI 1.05–2.38; p = 0.028) along with the presence of CI (OR = 2.41; 95% CI 1.60–3.64; p < 0.001). The administration of Cytoflavin at the basic therapy was accompanied by a statistically significant decrease in the frequency of sinus bradycardia and supraventricular extrasystole by day 5 of treatment (p < 0.05) both in the group of children after IVF and in children from spontaneous pregnancy.

Conclusion. Newborns conceived using IVF form an increased risk group for the development of myocardial depolarization disorders on the 3rd day of life. The greatest risk is observed when the IVF factor is combined with prematurity and CI. The use of Cytoflavin in premature infants with CI demonstrates a positive effect in correcting the identified CRD, which justifies the possibility of its use in this category of patients.

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