Recurrent Supraventricular Tachycardia and Necrotizing Enterocolitis: A Causative Role or a Simple Association? A Case Report and Literature Review

Abstract

Insufficiency in mesenteric flow is a risk factor for the development of necrotizing enterocolitis (NEC). Recurrent episodes of supraventricular tachycardia (SVT) can lead to gut ischemia, with subsequent reperfusion injury. We present a term infant who developed NEC at 37 days of life after refractory SVT and reverted to sinus rhythm on day 23 and 25 of life. Resected stenotic ileum and transverse colon demonstrated inflammation with ischemia. This is the first case of NEC following SVT in a term infant without a congenital morphologic abnormality. In view of the temporal sequence of events, and in the absence of other risk factors for NEC, the SVT and NEC were likely causally related.

Neonatal supraventricular tachycardia and necrotizing enterocolitis: case report and literature review

“…The association between NEC and SVT in newborns has been previously described in seven case reports in the literature Table 1 ) starting in 1998 [ 6 , 14 – 17 ]. Two cases were of full-term infants, and four were of preterm infants.…”

“…Two cases of late preterm infants, one with 1998 [17] LGA Large for gestationl age, IUGR Intrauterine growth restriction, NEC Necrotizing enterocolitis, SVT Supraventricular tachycardia, N.r Not reported in the article, Bpm Beats per minute, Cm Centimeters, g Grams intrauterine growth restriction (IUGR) and one large for gestational age (LGA), affected by NEC after recurrent episodes of SVT were presented by Saini et al in 2017 [6]. The most recent case report describes a full-term infant who was breastfed and developed NEC 3 days after SVT onset [14]. The seventh case was a 15-month-old boy who presented with shock and SVT following a 12-h history of worsening abdominal pain and vomiting reported by Jacombs et al [18].…”

“…The stabilization of cardiac output with control of SVT may cause oxygen free radical production with reperfusion injury. Persistent tachycardias can lead to haemodynamic compromise, but some authors suggest that NEC can also occur in infants affected by SVT without evidence of a significant haemodynamic compromise [14].…”

“…On contrast enema severe stenosis at the transverse colon, with dilated small bowel loops Surgery: resection of the stenotic transverse colon with end-end anastomosis, and ileal resection of a stenotic segment (2 cm) with end-end anastomosis. Laparotomy: Terminal ileum and a jejunal loop with omentum were solidly adherent to the stenotic transverse colon Nakib et al 2018 [ 14 ] 3 36 Weeks 2100 g (IUGR) 1′: 5 5′: 6 10′: 7 3rd day of life - 280 bpm - Hemodynamically stable. Echocardiogram: patent foramen ovale and a small patent ductus arteriosus - 7th day of life - Rectal bleeding.…”

“…A mechanism of intestinal hypoperfusion associated with NEC is the diving reflex , constituted by the redistribution of cardiac output to ensure brain and heart perfusion [ 20 ]. Recent literature reports suggest that recurrent episodes of SVT may predispose patients to NEC via disturbances in mesenteric blood flow [ 6 , 14 – 17 ]. During the haemodynamic instability caused by SVT, there is an increase in vascular resistance that reduces blood flow to the mesentery, known as the “steal phenomenon”.…”