Improving recognition and management of prolonged QT interval in children and neonates: impact of a targeted educational guideline for general paediatricians and neonatologists

Background

Long QT syndrome (LQTS) is a potentially lethal arrhythmia in paediatric and neonatal populations. Distinguishing congenital from secondary causes is critical to prevent misdiagnosis and sudden cardiac death. We developed a concise, evidence-based guideline, currently under second-round peer review in the European Journal of Pediatrics and refined with input from a world-leading expert in congenital LQTS, to support general paediatricians and neonatologists. This study evaluates how a survey linked to the guideline influences the confidence of UK paediatric and neonatal trainees.

Purpose

To assess the effect of the guideline on paediatric and neonatal trainees’ confidence in identifying and managing prolonged QT intervals.

Methods

Trainees completed pre- and post-intervention surveys assessing confidence and knowledge in QTc measurement, diagnostic thresholds, secondary causes, and clinical decision-making via case-based scenarios. Participants then reviewed the educational guideline. Responses were collected anonymously and analysed descriptively.

Results

A total of 60 paediatric and neonatal trainees completed the pre-guideline survey (33 senior, 27 junior residents), and 42 completed both the pre- and post-guideline surveys.

Before the intervention, only 25% (15/60) reported manually calculating QTc and 33% (20/60) used trusted applications applying Bazett’s formula. Another 17% (10/60) used applications without knowing which correction formula was applied, while 25% relied partly or entirely on the ECG machine. After exposure to the guideline, all respondents reported either manually verifying QTc or using validated applications with Bazett’s formula. None relied solely on machine-generated values.

Knowledge of QTc cut-off values improved from 70% correct responses pre-intervention to 100% post-intervention. For secondary/acquired causes of QT prolongation, only 3% initially identified a complete work-up, while 95% demonstrated correct investigation steps post-intervention before cardiology referral.

In case-based scenarios, confidence markedly improved: for an asymptomatic athlete with prolonged QTc, confidence in appropriate management rose from 13% to 100%. In neonatal cases with parental reluctance to start therapy, correct responses supporting early treatment increased from 35% to 74%. Overall, trainee confidence in recognising, investigating, and escalating prolonged QT cases increased from 28% to 98% post-guideline.

Conclusion

A concise, targeted educational guideline significantly improved paediatric and neonatal trainees’ confidence and accuracy in recognising and managing prolonged QT intervals. The intervention reduced reliance on automated ECG readings, enhanced understanding of QTc thresholds and secondary causes, and improved clinical decision-making. These results highlight the role of structured, targeted education in ensuring accurate diagnosis and timely, safe management of paediatric prolonged QT.QTc measurement methodsConfidence improvement