Sudden severe bradycardia in infancy

Kelly, Dorothy H.; Pathak, Ambadas; Meny, Robert G.

doi:10.1002/ppul.1950100312

Cited by 43 publications

(19 citation statements)

References 8 publications

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“…12 We believe that significant bradycardia occurs with a heart rate of fewer than 20 beats per minute or asystole greater than 6 seconds. Symptomatic bradycardia remains the most common indication for pace-maker implantation in the pediatric population.…”

Section: Discussionmentioning

confidence: 99%

Breath-Holding Spells Associated With Significant Bradycardia: Successful Treatment With Permanent Pacemaker Implantation

et al. 2001

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ABSTRACT. Objective. To determine whether children with pallid breath-holding spells associated with bradycardia can be treated safely and successfully with permanent pacemaker implantation.Methods. The records of pediatric patients who had apparent breath-holding spells and associated bradycardia and were treated with permanent pacemaker implantation were reviewed.Results. Ten pediatric patients with apparent breathholding spells associated with bradycardia were treated with a permanent ventricular demand pacemaker at the Mayo Clinic between 1985 and 1995. Patients had onset of symptoms between ages 6 days and 12 months and presented for evaluation between ages 12 months and 5 years. Duration of spells was 15 seconds to 10 minutes. Medications to prevent spells were unsuccessful. Electrocardiograms documented asystolic pauses of 1.7 to 24 seconds (mean: 11.9 seconds). Permanent ventricular demand pacemakers were implanted at 10 months to 5 years of age (median: 14.5 months): 9 endocardial and 1 epicardial. Three patients required pacemaker revision. At follow-up of 38 to 170 months (median: 65.5), 5 patients had complete resolution of spells, 2 had only mild color change without loss of consciousness or seizure activity, and 3 continued to have minor brief spells.Conclusions. Permanent pacemaker therapy for children with pallid breath-holding spells associated with severe bradycardia is safe, efficacious, and warranted. Pediatrics 2001;108:698 -702; bradycardia, breath-holding spells, pacemaker. ABBREVIATIONS. ECG, electrocardiogram; EEG, electroencephalogram.B reath-holding spells are widely known in the pediatric population. They usually are harmless, albeit distressing for the parents, and resolve with time. We report on 10 patients who presented with symptoms consistent with breathholding episodes. These events were more severe, prolonged, and incapacitating to the families than typical spells, and additional evaluation revealed that they were associated with significant bradycardia. We decided to implant permanent pacemakers in an attempt to alleviate or eliminate symptoms. 1,2 This article reviews these patients and assesses the long-term outcome of pacemaker treatment in this population. METHODSTen patients presented to the Mayo Clinic between 1985 and 1995 for further evaluation of apparent breath-holding spells or seizures (Table 1). Patients were identified by pacemaker records and Mayo Clinic master sheet summaries. Table 1 summarizes the patient characteristics, age at onset, symptoms during spells, age at pacemaker implantation, and course after pacemaker implantation. Their subsequent course was reviewed to evaluate shortand long-term outcomes. Follow-up information was obtained from the Mayo Clinic outpatient and inpatient records and from correspondence with referring physicians and parents. RESULTSThe records of 10 patients who received permanent ventricular demand pacemaker implantation for bradycardia associated with breath-holding spells were reviewed. Patients had onset of symptoms between ...

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Section: Discussionmentioning

confidence: 99%

Breath-Holding Spells Associated With Significant Bradycardia: Successful Treatment With Permanent Pacemaker Implantation

et al. 2001

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“…4 SIDS peaks in incidence at 2 to 4 months of age 5,6 and is believed to involve an uncompensated cardiovascular event presumed to occur during sleep, in conjunction with failure of the life-saving arousal response. [7][8][9][10][11] Preterm infants exhibit immature cardio-respiratory control, which persists past term-equivalent age, 12 is related to gestational age (GA) at birth, 13,14 and may contribute to their heightened risk for SIDS. 15 Prone sleeping is a major risk factor for SIDS, particularly among infants born preterm.…”

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confidence: 99%

Cerebral Oxygenation in Preterm Infants

et al. 2014

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BACKGROUND AND OBJECTIVE: Prone sleeping is a major risk factor for sudden infant death syndrome (SIDS) and preterm infants are at significantly increased risk. In term infants, prone sleeping is associated with reduced mean arterial pressure (MAP) and cerebral tissue oxygenation index (TOI). However, little is known about the effects of sleeping position on TOI and MAP in preterm infants. We aimed to examine TOI and MAP in preterm infants after term-equivalent age, during the period of greatest SIDS risk. METHODS: Thirty-five preterm and 17 term infants underwent daytime polysomnography, including measurement of TOI (NIRO-200 spectrophotometer, Hamamatsu Photonics KK, Japan) and MAP (Finapress Medical Systems, Amsterdam, Netherlands) at 2 to 4 weeks, 2 to 3 months, and 5 to 6 months postterm age. Infants slept prone and supine in active and quiet sleep. The effects of sleep state and position were determined by using 2-way repeated measures analysis of variance and of preterm birth by using 2-way analysis of variance. RESULTS: In preterm infants, TOI was significantly lower when prone compared with supine in both sleep states at all ages (P < .05). Notably, TOI was significantly lower in preterm compared with term infants at 2 to 4 weeks, in both positions (P < .05), and at 2 to 3 months when prone (P < .001), in both sleep states. MAP was also lower in preterm infants in the prone position at 2 to 3 months (P < .01). CONCLUSIONS: Cerebral oxygenation is reduced in the prone position in preterm infants and is lower compared with age-matched term infants, predominantly in the prone position when MAP is also reduced. This may contribute to their increased SIDS risk.

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“…It has been hypothesized that arousal impairment may play an important role in the etiology of sudden infant death syndrome (SIDS) (32,40,43,46). Moreover, many SIDS infants have repeated episodes of apnea and hypoxia in the days or weeks prior to death (44,56). We propose that repeated exposure to hypoxia during sleep leads to progressive lengthening of the time to arousal in response to hypoxia that might contribute to sudden death.…”

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Arousal from sleep in response to intermittent hypoxia in rat pups is modulated by medullary raphe GABAergic mechanisms

Darnall¹,

Schneider²,

Tobia³

et al. 2012

American Journal of Physiology-Regulatory, Integrative and Comp

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Darnall RA, Schneider RW, Tobia CM, Zemel BM. Arousal from sleep in response to intermittent hypoxia in rat pups is modulated by medullary raphe GABAergic mechanisms. Am J Physiol Regul Integr Comp Physiol 302: R551-R560, 2012. First published December 7, 2011; doi:10.1152/ajpregu.00506.2011Arousal is an important defense against hypoxia during sleep. Rat pups exhibit progressive arousal impairment (habituation) with multiple hypoxia exposures. The mechanisms are unknown. The medullary raphe (MR) is involved in autonomic functions, including sleep, and receives abundant GABAergic inputs. We hypothesized that inhibiting MR neurons with muscimol, a GABA A receptor agonist, or preventing GABA reuptake with nipecotic acid, would impair arousal and enhance arousal habituation and that blocking GABA A receptors with bicuculline would enhance arousal and attenuate habituation. Postnatal day 15 (P15) to P25 rat pups were briefly anesthetized, and microinjections with aCSF, muscimol, bicuculline, or nipecotic acid were made into the MR. After a ϳ30-min recovery, pups were exposed to four 3-min episodes of hypoxia separated by 6 min of normoxia. The time to arousal from the onset of hypoxia (latency) was determined for each trial. Latency progressively increased across trials (habituation) in all groups. The overall latency was greater after muscimol and nipecotic acid compared with aCSF, bicuculline, or noninjected controls. Arousal habituation was reduced after bicuculline compared with aCSF, muscimol, nipecotic acid, or noninjected pups. Increases in latency were mirrored by decreases in chamber [O2] and oxyhemoglobin saturation. Heart rate increased during hypoxia and was greatest in muscimol-injected pups. Our results indicate that the MR plays an important, not previously described, role in arousal and arousal habituation during hypoxia and that these phenomena are modulated by GABAergic mechanisms. Arousal habituation may contribute to sudden infant death syndrome, which is associated with MR serotonergic and GABAergic receptor dysfunction.␥-aminobutyric acid; sudden infant death syndrome; GABAA receptor; habituation IN HUMAN INFANTS, AROUSAL is an important protective mechanism against hypoxia during sleep. Spontaneous arousals and those in response to exogenous stimuli are affected by many factors: sleep position (3, 29, 37), sleep efficiency (30), prenatal exposure to cigarette smoking (28, 38), and stage of development (39). It has been hypothesized that arousal impairment may play an important role in the etiology of sudden infant death syndrome (SIDS) (32,40,43,46). Moreover, many SIDS infants have repeated episodes of apnea and hypoxia in the days or weeks prior to death (44,56). We propose that repeated exposure to hypoxia during sleep leads to progressive lengthening of the time to arousal in response to hypoxia that might contribute to sudden death.We and others have shown in newborn and infant rodents (17, 18, 21), lambs (25,41,42), and piglets (71) that repeated brief exposures to mild hypoxia result in...

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Sudden severe bradycardia in infancy

Cited by 43 publications

References 8 publications

Breath-Holding Spells Associated With Significant Bradycardia: Successful Treatment With Permanent Pacemaker Implantation

Breath-Holding Spells Associated With Significant Bradycardia: Successful Treatment With Permanent Pacemaker Implantation

Cerebral Oxygenation in Preterm Infants

Arousal from sleep in response to intermittent hypoxia in rat pups is modulated by medullary raphe GABAergic mechanisms

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