Conjugated hyperbilirubinemia in a newborn infant after maternal (transplacental) treatment with flecainide acetate for fetal tachycardia and fetal hydrops

Vanderhal, Andre; Cocjin, Jose; Santulli, Thomas V.; Carlson, Dru E.; Rosenthal, Philip

doi:10.1016/s0022-3476(95)70230-x

Cited by 11 publications

(4 citation statements)

References 4 publications

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“…At least 36 cases, including ours, of maternal flecainide administration for the treatment of fetal arrhythmias are documented in the literature with no reports of significant maternal adverse effects (1,3,4,8).…”

Section: Discussionmentioning

confidence: 87%

Transplacental Flecainide Therapy for Fetal Supraventricular Tachycardia in a Twin Pregnancy

Edwards

Peek

Curren

1999

Aust NZ J Obst Gynaeco

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We present the case of a twin pregnancy in which 1 fetus developed hydrops secondary to supraventricular tachycardia at 30 weeks' gestation. Transplacental flecainide administration successfully treated the condition without evidence of maternal or fetal side-effects. The case raises ethical and possibly legal issues that present when 1 fetus in a twin pregnancy develops a condition the management of which could cause complications to the other twin and/or the mother.

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Section: Discussionmentioning

confidence: 87%

Transplacental Flecainide Therapy for Fetal Supraventricular Tachycardia in a Twin Pregnancy

Edwards

Peek

Curren

1999

Aust NZ J Obst Gynaeco

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“…Moreover, tlecanide--is known to cause bradycardia as a side-effect and is used with caution in pregnancy because of the possibility of toxicity. 6 But no maternal or cord blood )evels of flecanide were done to prove this.…”

Section: Discussionmentioning

confidence: 99%

“…The fetal bradycardia could probably be secondary to maternal flecanide, because there was no evidence of fetal distress due to any other cause. Moreover, flecanide is known to cause bradycardia as a side‐effect and is used with caution in pregnancy because of the possibility of toxicity 6 . But no maternal or cord blood levels of flecanide were done to prove this.…”

Section: Discussionmentioning

confidence: 99%

Supraventricular Tachycardia With Hydrops in a 27‐week Premature Baby

Abraham

2001

Int J Clinical Practice

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SUMMARYA 27‐week baby with antenatally diagnosed supraventricular tachycardia (SVT) and hydrops fetalis was delivered by emergency caesarean section because of severe fetal bradycardia. The mother was on flecanide to control the fetal SVT. The baby was hydropic at birth and required prolonged ventilatory support. On day 6, he developed acute renal failure for which peritoneal dialysis was done. On day 23, he developed several episodes of supraventricular tachycardia (SVT) which did not respond to intravenous adenosine and amiodarone and ultimately required intravenous flecanide. This case report highlights the management of a critically ill premature hydropic baby with resistant SVT, and the successful outcome.

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“…An extensive evaluation did not disclose a cause and the authors attributed the condition to an adverse effect of flecainide. [70] Flecainide has negative inotropic effects and development of, or worsening of, congestive heart failure occurs in 2 to 5% of patients. [71] Flecainide does generally not prolong the QT segment; [72] however, one report described marked QT segment anomalies in a newborn who was treated with flecainide prenatally.…”

Section: Adverse Effects and Precautionsmentioning

confidence: 99%

Drug Treatment of Fetal Tachycardias

et al. 2002

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The pharmacological treatment of fetal tachycardia (FT) has been described in various publications. We present a study reviewing the necessity for treatment of FT, the regimens of drugs used in the last two decades and their mode of administration. The absence of reliable predictors of fetal hydrops (FH) has led most centers to initiate treatment as soon as the diagnosis of FT has been established, although a small minority advocate nonintervention. As the primary form of pharmacological intervention, oral maternal transplacental therapy is generally preferred. Digoxin is the most common drug used to treat FT; however, effectiveness remains a point of discussion. After digoxin, sotalol seems to be the most promising agent, specifically in atrial flutter and nonhydropic supraventricular tachycardia (SVT). Flecainide is a very effective drug in the treatment of fetal SVT, although concerns about possible pro-arrhythmic effects have limited its use. Amiodarone has been described favorably, but is frequently excluded due to its poor tolerability. Verapamil is contraindicated as it may increase mortality. Conclusions on other less frequently used drugs cannot be drawn. In severely hydropic fetuses and/or therapy-resistant FT, direct fetal therapy is sometimes initiated. To minimize the number of invasive procedures, fetal intramuscular or intraperitoneal injections that provide a more sustained release are preferred. Based on these data we propose a drug protocol of sotalol 160 mg twice daily orally, increased to a maximum of 480 mg daily. Whenever sinus rhythm is not achieved, the addition of digoxin 0.25 mg three times daily is recommended, increased to a maximum of 0.5 mg three times daily. Only in SVT complicated by FH, either maternal digoxin 1 to 2mg IV in 24 hours, and subsequently 0.5 to 1 mg/day IV, or flecainide 200 to 400 mg/day orally is proposed. Initiating direct fetal therapy may follow failure of transplacental therapy.

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Conjugated hyperbilirubinemia in a newborn infant after maternal (transplacental) treatment with flecainide acetate for fetal tachycardia and fetal hydrops

Cited by 11 publications

References 4 publications

Transplacental Flecainide Therapy for Fetal Supraventricular Tachycardia in a Twin Pregnancy

Transplacental Flecainide Therapy for Fetal Supraventricular Tachycardia in a Twin Pregnancy

Supraventricular Tachycardia With Hydrops in a 27‐week Premature Baby

Drug Treatment of Fetal Tachycardias

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