Serum Digoxin Concentrations in the Human Fetus, Neonate and Infant

Rogers, Mark C.; Willerson, James T.; Goldblatt, Allan; Smith, Thomas W.

doi:10.1056/nejm197211162872003

Cited by 163 publications

(43 citation statements)

References 11 publications

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“…The basis for the treatment were studies on the placental transfer of the two drugs used. ROGERS [5] demonstrated that digoxin concentrations in the umbilical biood was the same äs that in the maternal blood in women who received longterm digitalis treatment because of heart disease. Therefore, a free transfer of digoxin must be assumed.…”

Section: Discussionmentioning

confidence: 95%

Prenatal diagnosis and therapy of fetal heart rate anomalies: With a contribution on the placental transfer of Verapamil

Wolff¹,

Breuker²,

Schlensker³

et al. 1980

Journal of Perinatal Medicine

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Section: Discussionmentioning

confidence: 95%

Prenatal diagnosis and therapy of fetal heart rate anomalies: With a contribution on the placental transfer of Verapamil

Wolff¹,

Breuker²,

Schlensker³

et al. 1980

Journal of Perinatal Medicine

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“…The need for higher doses of digoxin in newborn infants to achieve satisfactory therapeutic effect has earlier been described (Park 1986), which complicates the clinical interpretation of S-digoxin values (Rogers et al 1972). The need for higher doses could be due to a larger concentration of N π -K π -ATPase in the myocardium (Kjeldsen & Grøn 1990).…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal Symptoms as an Important Sign in Premature Newborns with Severely Increased S‐Digoxin

Nybo

Damkier

2005

Basic Clin Pharma Tox

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Abstract:The aim is to emphasize the importance of extracardiac symptoms of digoxin intoxication in newborns. The most common intoxication symptoms in adults are of cardiac origin, but due to altered symptomatology, digoxin overdose in infants are not always discovered on symptomatic basis. In preterm infants, this is even more pronounced due to diminished digoxin sensitivity. Also, tissue distribution is altered in newborns, which, combined with the need for higher doses in newborns to obtain clinical effect, underscores the need for the utmost care, when newborns receive digoxin treatment to avoid intoxication. We report a case of severe digoxin intoxication in a preterm newborn infant, leading to distinct gastrointestinal symptoms, but only minor cardiac affection. The literature concerning digoxin intoxication and digoxin measurement is reviewed to elucidate the case report. In conclusion, alertness should be drawn to extracardiac symptoms of digoxin intoxication, especially in newborns, and P-Potassium can serve as a predictor and thereby strengthen any given suspicion. Therapeutic drug monitoring should be performed, as soon as digoxin overdose due to the abovementioned signs is suspected in spite of vague cardiac symptoms.

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“…Infants can tolerate higher digoxin plasma levels with a lesser incidence of cardiotoxicity than adults (Rogers et al, 1972;Hayes et al, 1973), despite myocardial: plasma ratios which are as great, and some have thought greater (Hernandez et al, 1969;Gorodischer et al, 1976;Wettrell and Andersson, 1977). Finally, a number of studies have suggested a lesser myocardial effect of glycosides at a cellular level in young animals.…”

Section: Discussionmentioning

confidence: 99%

“…INFANTS tolerate higher doses of digitalis relative to body weight or surface area than adults (Sapin et al, 1956;Neill, 1965;Wettrell and Andersson, 1977), and higher serum levels of digoxin can be maintained in infants and children without the development of cardiac arrhythmias (Rogers et al, 1972;Hayes et al, 1973). Young animals also are relatively tolerant of digitalis, and there is some evidence that the myocardial effects of the cardiac glycosides are age dependent (Wollenberger et al, 1953;Boerth, 1975;Rosen et al, 1975;Berman et al, 1977).…”

mentioning

confidence: 99%

Age dependence of myocardial Na+-K+-ATPase activity and digitalis intoxication in the dog and guinea pig.

Lloyd¹,

Taylor²

1981

Circulation Research

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SUMMARY Infants and young animals tolerate higher doses of digitalis glycosides, relative to body weight, than adults. One possible explanation for this could be an age-dependent difference in the myocardial digitalis receptor, the Na + -K + -ATPase. Two functions of this enzyme were studied in adult, 1-and 6-week-old dogs and guinea pigs: in vitro myocardial uptake of rubidium ( 86 Rb) and binding of ouabain. In guinea pigs, rubidium uptake (pmol Rb/mg LV per 15 min) was: 1 week old: 100.9 ± 7.1 (mean + SE); 6 week: 79.8 ± 6.7; adult: 55.2 ± 7.9; (1 week: 6 week: P< 0.025; 1 week: adult, P< 0.001; 6 week: adult, P < 0.025). Similarly in dogs, rubidium uptake was significantly greater at 1 week than at 6 weeks (208 ± 13 vs. 144 ± 9; P < 0.001) and the latter greater than in adults (111 ± 4) (P < 0.005). Other groups of anesthetized adult and 6-week-old dogs were given digoxin, 0.3 mg/kg, iv. The young dogs took significantly longer to become cardiotoxic (17.3 ± 3.4 min vs. 9.3 ± 1.4 min; P< 0.025), while their myocardial digoxin uptake was at least as great. Rubidium uptake showed an average decrease of 56% after digoxin but residual uptakes were not different in the two groups. Data for ouabain binding showed similar differences between the various groups of dogs studied. Increased myocardial Na + -K + -ATPase activity, reflected in greater active cation transport and specific enzyme binding, has been demonstrated in young animals and may be partly responsible for their greater tolerance to digitalis glycosides. Circ Res 48: 329-333, 1981

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Serum Digoxin Concentrations in the Human Fetus, Neonate and Infant

Cited by 163 publications

References 11 publications

Prenatal diagnosis and therapy of fetal heart rate anomalies: With a contribution on the placental transfer of Verapamil

Prenatal diagnosis and therapy of fetal heart rate anomalies: With a contribution on the placental transfer of Verapamil

Gastrointestinal Symptoms as an Important Sign in Premature Newborns with Severely Increased S‐Digoxin

Age dependence of myocardial Na+-K+-ATPase activity and digitalis intoxication in the dog and guinea pig.

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