Supraventricular Tachycardia in Infants With Congenital Diaphragmatic Hernia: Prevalence, Associations, and Outcomes

Abstract

To characterize the prevalence, associations, management, and outcomes of supraventricular tachycardia (SVT) in neonates with congenital diaphragmatic hernia (CDH). DESIGN:Retrospective chart and cardiology code review within a cohort of patients with CDH was used to define a subpopulation with atrial arrhythmia. SVT mechanisms were confirmed by electrocardiogram analysis. Cox proportional hazard regression identified risk factors for SVT and association with clinical outcomes.SETTING: Medical Surgical ICU in a single, tertiary center, Boston Children's Hospital. PATIENTS:Eligible patients included neonates presenting with classic Bochdalek posterolateral CDH between 2005 and 2017, excluding newborns with Morgagni hernia or late diagnoses of CDH (>28 d). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:SVT arose in 25 of 232 neonates with CDH, (11%); 14 of 25 infants (56%) had recurrent SVT; atrioventricular node-dependent tachycardia was the most frequent mechanism (32%). The majority (71%) of SVT episodes received intervention. Nine patients (36%) received preventative antiarrhythmic medications. SVT was associated with lower Apgar score at 1 min, structural heart disease, larger defect size, extracorporeal membrane oxygenation (ECMO) support, and prostaglandin therapy for ductal patency as well as hospital stay greater than or equal to 8 weeks and use of supplemental oxygen at discharge. CONCLUSIONS:SVT can occur in neonates with CDH and frequently requires treatment. Odds of occurrence are increased with greater CDH disease severity, ECMO, and prostaglandin use. In unadjusted logistic regression analysis, SVT was associated with adverse hospital outcomes, underscoring the importance of recognition and management in this vulnerable population.

Antiarrhythmic Drug Dosing in Children—Review of the Literature

“…Flecainide may cause dizziness, visual disturbance, dyspnea, chest pain, or proarrhythmia. The latter is reported especially for patients with Brugada syndrome and is reported as a potential fatality [2,[22][23][24][25][26][27][28][29][30][31][32][33][34].…”

“…The duration of action is reported to be up to 30 min. Esmolol may cause arterial hypotension, confusion, nausea, vomiting, headache, agitation, or infusion site reactions including inflammation or induration, among others [24,31,36,[52][53][54][55][56][57].…”

Editor’s Choice Articles for July

“…Tella JB, Dao DT, Alexander ME, et al: Supraventricular Tachycardia in Infants With Congenital Diaphragmatic Hernia: Prevalence, Associations, and Outcomes (3).…”

“…Cardiology, General Surgery, and Critical Care specialists combine in this multidisciplinary, single-center investigation of supraventricular tachycardia in a population of 232 neonates with congenital diaphragmatic hernia (3). An important reference of contemporary practice–read and you won’t forget where to find it should the clinical need arise in the future.…”

“…So many excellent reads this month. Besides my three Editor’s Choices (1‐3), there is also PCCM Connections for Readers, which this month focuses on what we learn from epidemiology (4‐8). Of course, there is much more to read in PCCM with another three articles on acute kidney injury, three more articles on perioperative intensive care for patients with congenital heart disease, and an addition to the growing PCCM Narrative catalog.…”