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Neonatal Intensive Care Drug Manual
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| bet | 179/654 | | Sana | 03.01.2022 | | Hajmi | 1,5 Mb. | | #14803 |
Atrial flutter: Atrial flutter can occur in fetuses and neonates with structurally normal hearts. Comorbid conditions are not usually present; however, cases of atrial flutter associated with neonatal Coxsackie myocarditis and following maternal treatment with lithium have been reported. Neonatal atrial flutter rarely reoccurs following cardioversion with or without medical treatment. In the newborn with atrial flutter, initial therapy with digoxin has been the traditional approach. However, this has never been demonstrated to be any more efficacious than primary electrical cardioversion. [16] Casey et al reported a case series of 25 newborns with atrial flutter; 7 of 21 converted to sinus rhythm with digoxin therapy and electrical conversion resulted in sustained sinus rhythm in 9 of 16 patients (13 after failure of digoxin and 3 as the first treatment). Sinus rhythm was achieved in 23 patients and two died of complications of prematurity without resolution of atrial flutter.[20] Texter et al 2006 reported a case series of 50 infants with atrial flutter, 72% presented within the first 48 hours of life. Sinus rhythm was restored in 20 of 23 (87%) attempts at direct current cardioversion and 7 of 22 (32%) attempts at transoesophageal pacing; 7 required antiarrhythmic therapy. An additional arrhythmia, all supraventricular, appeared in 11 (22%) infants. The recurrence of atrial flutter developed in 6 infants all with an additional arrhythmia. Twelve received digoxin loading as first-line therapy. Sinus rhythm occurred in 4 infants within hours of beginning the digoxin load; the remaining eight required additional intervention.[21]
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