Preterm Infants with Paroxysmal Supraventricular Tachycardia: Presentation, Response to Therapy, and Outcome (original) (raw)
Related papers
International Journal of Basic & Clinical Pharmacology
Background: Patency of ductus arteriosus is vital for fetal survival. Ductus often fails to close in premature infants called patent ductus arteriosus (PDA). Our objective is to find the clinical profile and assess the outcome of preterm infants diagnosed to have clinically significant PDA.Methods: 20 infants diagnosed as PDA clinically and confirmed by echocardiography. Symptomatic infants initially treated with fluid restriction and frusemide. Non responders treated with per rectal ibuprofen with dose of 10 mg/kg stat followed by 5 mg/kg x 2 doses at 24 hour intervals. Failure to ductal closure followed by similar second course of ibuprofen. Echocardiography repeated after 72 hours of each therapy. Surgical ligation of ductus was carried after failure to drug therapies. Secondary outcomes during hospitalization were documented.Results: PDA was diagnosed in seventeen infants during first week and three after seven postnatal day. Mean gestational age and birth weight were 31±2 weeks...
Neonatal Supraventricular Tachycardia (SVT)
NeoReviews, 2005
A male neonate born at 31 weeks' gestation had a history of fetal supraventricular tachycardia (SVT) detected at 28 weeks' gestation, with no hydropic changes noticed on ultrasonography. The mother was started on enteral digoxin with instructions for weekly follow-up. On her first return visit at 31 weeks' gestation, ultrasonography revealed hydropic changes and persistent SVT. An emergency cesarean section was performed, and the infant was found to have hydrops and respiratory distress, with a heart rate of 270 beats/min. The patient was intubated and mechanically ventilated and received a dose of intravenous (IV) adenosine, resulting in a transient decrease in heart rate to 120 beats/min before increasing back to 260 to 270 beats/ min. SVT persisted despite institution of an esmolol drip at 500 mcg/kg per minute, and cardioversion was performed when hemodynamic instability developed. Recurrent SVT, associated with hypotension, developed within 45 minutes of successful cardioversion. The patient was given a loading dose of amiodarone, followed by cardioversion, continuous amiodarone, and dobutamine infusion. Echocardiography revealed normal anatomy with moderately reduced function. The patient remained in sinus rhythm and was weaned to oral amiodarone after 1 week of infusion. An echocardiogram revealed normal function. The patient was discharged from the hospital receiving 3 mg/kg per day of oral amiodarone.
Perinatal management and long-term cardiac outcome in fetal arrhythmia
Early Human Development, 2011
Background: Cardiac arrhythmias are commonly observed in the fetus, however, may have major consequences for fetal development and post natal life. Aims: To evaluate the perinatal management and cardiac outcome of fetuses with tachy-or bradyarrhythmia. Study design: Perinatal management, outcome and long-term cardiac follow-up were evaluated retrospectively in consecutive fetuses with cardiac arrhythmias. Results: Forty-four fetuses were diagnosed: supraventricular tachycardia (SVT, n = 28), atrial flutter (AF, n = 7) and atrioventricular block (AVB, n = 9). The overall incidence of cardiac anomalies was 18% mainly in the AVB group; hydrops was present in 34%. Direct or transplacental fetal anti-arrhythmic medication was given in 76%. Mortality was 6% in SVT/AF and 78% in the AVB group, respectively. AF resolved in all patients. In the SVT group, Wolff-Parkinson-White (WPW) syndrome was present in 21%, diagnosed at birth or later in life. After the age of one year about 90% of patients in the SVT group remained asymptomatic and free of drugs (median follow-up 76 months). Conclusions: Mortality rate is low in patients with fetal SVT and AF but high in patients with AVB. Related morbidity includes WPW-syndrome and congenital cardiac anomalies. Electrocardiographic screening is recommended in all fetal SVT cases before adolescence since WPW-syndrome may occur later in life.
Is hypotension a major risk factor for neurological morbidity at term age in very preterm infants?
Early Human Development, 2003
Objective: To investigate the influence of perinatal risk factors, especially hypotension, on neuromotor status at term in surviving preterm infants born before 32 weeks of gestation. Methods: This study is part of the Leiden Follow-Up Project on Prematurity: a prospective, regional study of 266 live born infants with a gestational age < 32 weeks born in 1996 -1997. Twenty-eight infants died before term age. Two hundred and eleven infants were examined neurologically at term according to Prechtl. The findings were classified as normal (N), mildly abnormal (MA) or definitely abnormal (DA). Hypotension was defined as a mean arterial blood pressure < 30 mmHg on at least two occasions. Results: One hundred and six (50%) infants were classified as neurologically N, 92 (44%) infants were classified as MA and 13 (6%) infants as DA. Hypotension, bronchopulmonary dysplasia, flaring and cystic periventricular leucomalacia were risk factors for neurological morbidity. Of the 68 infants with hypotension 33 (49%) were classified as MA and 7 (10%) as DA. Of the 141 infants without hypotension 58 (41%) were MA, and 5 (4%) were DA. The odds ratio of hypotension for neurological morbidity was 1.9 (95% CI 1.06 -3.40), adjusted for gestational age, birth weight, small for gestational age and gender it was 1.96 (95% CI 1.02 -3.77). The adjusted odds ratio of PVL was 18.6 (4.4 -78.5), of flaring was 2.37 (1.18 -4.74) and of BPD was 2.44 (1.08 -5.5). Conclusions: Apart from gestational age, periventricular leucomalacia, and bronchopulmonary dysplasia, hypotension in preterm infants is a major risk factor for neurological morbidity at term.
Respiratory symptoms in preterm infants: burden of disease in the first year of life
2011
Objective: While respiratory symptoms in the first year of life are relatively well described for term infants, data for preterm infants are scarce. We aimed to describe the burden of respiratory disease in a group of preterm infants with and without bronchopulmonary dysplasia (BPd) and to assess the association of respiratory symptoms with perinatal, genetic and environmental risk factors. Methods: single centre birth cohort study: prospective recording of perinatal risk factors and retrospective assessment of respiratory symptoms during the first year of life by standardised questionnaires. Main outcome measures: Cough and wheeze (common symptoms), re-hospitalisation and need for inhalation therapy (severe outcomes). Patients: 126 preterms (median gestational age 28.7 weeks; 78 with, 48 without BPd) hospitalised at the university Children's Hospital of Bern, switzerland 1999Bern, switzerland -2006. Results: Cough occurred in 80%, wheeze in 44%, rehospitalisation in 25% and long term inhalation therapy in wheezers in 13% of the preterm infants. using logistic regression, the main risk factor for common symptoms was frequent contact with other children. severe outcomes were associated with maximal peak inspiratory pressure, arterial cord blood pH, aPGaRand CRIB-score. Conclusions: Cough in preterm infants is as common as in term infants, whereas wheeze, inhalation therapy and re-hospitalisations occur more often. severe outcomes are associated with perinatal risk factors. Preterm infants who did not qualify for BPd according to latest guidelines also showed a significant burden of respiratory disease in the first year of life.
Fetal supraventricular tachycardia diagnosed and treatedat 13 weeks of gestation: a case report
Ultrasound in Obstetrics and Gynecology, 2003
When SVT is sustained, congestive heart failure and fetal hydrops may ensue, due to both systolic and diastolic dysfunction. Sonographic diagnosis is usually incidental during the second or third trimester. Treatment goals are cardioversion to sinus rhythm and reversal of cardiac dysfunction. We describe a case of fetal SVT diagnosed at 13 weeks of gestation. Treatment with digoxin and flecainide was successful; the heart rate returned to sinus rhythm within one day, and fetal hydrops resolved within 8 days of treatment. We suspect that as more first-trimester examinations are performed, more cases with SVT will be diagnosed. We discuss the treatment protocol, and suggest that co-administration of two drugs that act synergistically may be more efficient than monotherapy, which is currently used as the first line of treatment. In addition, we discuss the potentially deleterious effect of heart failure encountered at an early developmental stage on the central nervous system. More data need to be collected in order to substantiate a clear recommendation regarding optimal management.
Summary proceedings from the cardiology group on cardiovascular instability in preterm infants
Pediatrics, 2006
The appropriate determination of adequate tissue perfusion and the best approach to treatment of perceived abnormalities in blood pressure in the neonate remain controversial. There is no consensus regarding the actual definition of hypotension in the neonate or how best to raise perceived low blood pressure. In addition, there is no direct and prospectively collected information available on the result of treatment of a "low" blood pressure on neonatal morbidity and mortality. It also has not been clearly demonstrated that bringing systemic blood pressure to a "normal" range improve outcomes. However, it is widely accepted by clinicians that early and aggressive treatment of hypotension leads to improved neurologic outcome and survival in the neonate. Commonly used therapeutic maneuvers to correct systemic hypotension in the neonate include volume expansion, inotropic agents, and corticosteroids. Although there is a paucity of research on the cardiovascular resp...