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Prospective cohort study of neonates with electrocardiography (ECG) and echocardiography performed during the first month of life. Left ventricular mass index (LVMI) was determined by echocardiography and the correlation with electrocardiographic markers of LVMI outliers (\u2265\u200998th percentile) were analyzed. We included 17,450 neonates (52% boys; median age at examination 11\u00a0days) and found an increase in median QRS duration and LVMI during the first month of life (54 vs. 56\u00a0ms and 24.7 vs. 28.6\u00a0g\/m<jats:sup>2<\/jats:sup> at days 0\u20134 and 25\u201330, respectively; both <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). All investigated ECG features (QRS duration, QRS area\u00a0in V1\/V6, maximum amplitudes\u00a0of\u00a0S-V1\/R-V6, and the Sokolow\u2013Lyon voltage product) showed no to low correlation with LVMI, resulting in low sensitivities (0\u20139.0%), but high specificities (97.2\u201398.1%), and area under the curve values close to the identity line (0.49\u20130.61) for identifying LVMI outliers. Adjustment of outlier definition for LVMI and threshold for QRS features had no significant effect on sensitivity. We present reference values for QRS complex features and their association with LVMI in neonates from a large, unselected, population-based cohort. The QRS complex gradually evolved during the first month of life but had a low correlation with LVMI. Our results indicate a poor diagnostic value of using ECG features to identify LVMI outliers in neonates.<\/jats:p><jats:p><jats:italic>Trial Registry<\/jats:italic> Copenhagen Baby Heart, NCT02753348, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltri-als.gov\/ct2\/show\/NCT02753348?cond=Copenhagen+Baby+Heart&amp;draw=2&amp;rank=1\">https:\/\/clinicaltri-als.gov\/ct2\/show\/NCT02753348?cond=Copenhagen+Baby+Heart&amp;draw=2&amp;rank=1<\/jats:ext-link>, deidentified individual participant data will not be made available.<\/jats:p>","DOI":"10.1007\/s00246-023-03361-0","type":"journal-article","created":{"date-parts":[[2023,12,27]],"date-time":"2023-12-27T23:02:24Z","timestamp":1703718144000},"page":"248-256","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Neonatal QRS Complex and Its Association with Left Ventricular Mass"],"prefix":"10.1007","volume":"45","clinical-trial-number":[{"clinical-trial-number":"nct02753348","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Julie","family":"Molin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joachim","family":"Hartmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Munk","family":"P\u00e6rregaard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline Boye","family":"Thygesen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne-Sophie","family":"Sillesen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna Axelsson","family":"Raja","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruth Ottilia Birgitta","family":"V\u00f8gg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kasper Karmark","family":"Iversen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henning","family":"Bundgaard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex H\u00f8rby","family":"Christensen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,12,27]]},"reference":[{"key":"3361_CR1","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1111\/echo.13782","volume":"35","author":"F Vancheri","year":"2018","unstructured":"Vancheri F, Vancheri S, Henein M (2018) Relationship between QRS measurements and left ventricular morphology and function in asymptomatic individuals. 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