Diagnosis And Treatment For Paroxysmal Supraventricular Tachycardia In Neonates

Objective:Study of clinical diagnosis and treatment on neonates with paroxysmal supraventricular tachycardia (PSVT).Method:A retrospective analysis of28neonates at full term or earlier between the year january1997till may2001with paroxysmal supraventricular tachycardia at the Tianjin children’s hospital. Their last attack the types of PSVT, the severity of the event, the mechanism of action of PVST and its treatment was observed. All children were treated with propafenone and amiodarone. The treatment proved effective. Heart failure patients were treated with digoxin18hours fast till saturation. The neonates with enlarged liver had liver retracted. After propafenone administration or amiodarone therapy their cardiac failure resolved. The diagnosis with ECG or Holter ECG device and Echocardiography was done.Result:The above group of children admitted to the hospital were treated with oxygen and symptomatic sedative therapy.3patients of PSVT automatically aborted. Another8patients were given intravenous bolus dose of propafenone (1-2mg/kg) and they were instantly reverted to sinus rhythm.12other patients admitted with congestive heart failure were treated with digoxin18hours saturation but however had mild improvement and their liver was not fully retracted. Their breathing rate slowed down after propafenone or amiodarone administration.Note that the heart rate of the admitted neonates instantly converted to sinus rhythm.4infants with severe cardiogenic shock had low blood pressure fluctuating between40mmHg-60mmHg and were given i.v dopamine (4μg/kg) and sodium nitroprusside(2μg/kg)fast until saturation. Their blood pressure increased to normal after propafenone or other antiarrhythmic drugs were administered.4cases of neonates were effectively treated and their heart rate was converted to sinus rhythm.Conclusion:1. PSVT in neonates may have several different underlying mechanisms. PSVT consists mainly of excessive crying, poor feeding, lethargia, pallor and cyanosis, low blood pressure, shortness of breath, In some cases heart failure and cardiogenic shock may be present.2. General rules regarding acute therapy are similar for most forms of paroxysmal tachycardia. On auscultation in neonates usually tachycardia is heard. ECG or24hour Holter monitoring have so far been the most reliable source of investigation.3. PSVT with CHF and cardiogenic shock have proven to be life threatening. Firstly drug therapy with digoxin, improve circulation than can use propafenone assures safe recovery in most of the cases.