Infants with congenital complete heart block




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Infants with congenital complete heart block: Case reports of response to isoprenaline infusion in newborns with congenital heart block.[2-4] (LOE IV, GOR D)

Children with asthma: Case series report response to isoprenaline infusion in infants and children with asthma. [5, 6] (LOE IV, GOR D)

The European Society of Cardiology Guidelines recommend for patients with bradyarrhythmia, positive chronotropic drug infusion (e.g. isoprenaline, adrenaline (epinephrine), etc.) may be preferred for a limited time, unless there is a contra-indication, compared to use of a temporary pacemaker. [7]

These are insufficient data reported to determine its safety or efficacy in newborns with pulmonary hypertension.

Safety:


Case reports of arrhythmia/tachycardia [8] [6], elevated serum CPK-MB levels [9] and hypotension.[10] In animal studies, use of isoprenaline hydrochloride in conjunction with aminophylline and corticosteroids have been shown to be additive in cardiotoxic properties and can lead to myocardial necrosis and death.13

Pharmacokinetics:

In children age 2 days to 14 years, average plasma half-life 4.2 ± 1.5 minutes, with linear relationship between steady state concentration and dosing rate.[11]


References

1. Noori S, Seri I. Neonatal blood pressure support: the use of inotropes, lusitropes, and other vasopressor agents. Clinics in perinatology. 2012;39:221-38.

2. Deloof E, Devlieger H, Van Hoestenberghe R, Van den berghe K, Daenen W, Gewillig M. Management with a staged approach of the premature hydropic fetus due to complete congenital heart block. European Journal of Pediatrics. 1997;156:521-3.

3. Glatz AC, Gaynor JW, Rhodes LA, Rychik J, Tanel RE, Vetter VL, Kaltman JR, Nicolson SC, Montenegro L, Shah MJ. Outcome of high-risk neonates with congenital complete heart block paced in the first 24 hours after birth. The Journal of thoracic and cardiovascular surgery. 2008;136:767-73.

4. Quek SC, Low KT, Sim EK, Joseph R. A case report on the perinatal management of a 30-week preterm baby with congenital complete heart block. Annals of the Academy of Medicine, Singapore. 2000;29:510-3.

5. Bohn D, Kalloghlian A, Jenkins J, Edmonds J, Barker G. Intravenous salbutamol in the treatment of status asthmaticus in children. Critical care medicine. 1984;12:892-6.

6. Herman JJ, Noah ZL, Moody RR. Use of intravenous isoproterenol for status asthmaticus in children. Critical care medicine. 1983;11:716-20.

7. Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, Cleland J, Deharo JC, Delgado V, Elliott PM, Gorenek B, Israel CW, Leclercq C, Linde C, Mont L, Padeletti L, Sutton R, Vardas PE, Guidelines ESCCfP, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Document R, Kirchhof P, Blomstrom-Lundqvist C, Badano LP, Aliyev F, Bansch D, Baumgartner H, Bsata W, Buser P, Charron P, Daubert JC, Dobreanu D, Faerestrand S, Hasdai D, Hoes AW, Le Heuzey JY, Mavrakis H, McDonagh T, Merino JL, Nawar MM, Nielsen JC, Pieske B, Poposka L, Ruschitzka F, Tendera M, Van Gelder IC, Wilson CM. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). European heart journal. 2013;34:2281-329.

8. Steiner P, Rao M, Ehrlich R, Padre R. The use of intravenous isoproterenol in the treatment of status asthmaticus. The Journal of asthma research. 1975;12:215-9.

9. Maguire JF, Geha RS, Umetsu DT. Myocardial specific creatine phosphokinase isoenzyme elevation in children with asthma treated with intravenous isoproterenol. The Journal of allergy and clinical immunology. 1986;78:631-6.

10. Kussman BD, Madril DR, Thiagarajan RR, Walsh EP, Laussen PC. Anesthetic management of the neonate with congenital complete heart block: a 16-year review. Paediatric anaesthesia. 2005;15:1059-66.

11. Reyes G, Schwartz PH, Newth CJ, Eldadah MK. The pharmacokinetics of isoproterenol in critically ill pediatric patients. Journal of clinical pharmacology. 1993;33:29-34.

12. Australian Injectable Drugs Handbook 6th edition. http://aidh.hcn.com.au/browse/i/isoprenaline_hydrochloride Accessed on 8 August 2016.

13. Vick J, Joseph X, Whitehurst V, Herman E, Balazs T. Cardiotoxic effects of the combined use of caffeine and isoproterenol in the minipig. J Toxicol Environ Health. 1989;26(4):425-35.

14. Micromedex.com. Accessed on 8 August 2016.






Original version Date: 6/10/2016

Author: NMF Consensus Group

Current Version number: 1

Current Version Date: December 2019

Risk Rating: Medium

Due for Review: December 2022

Approval by: DTC

Approval Date: December 2019



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Infants with congenital complete heart block

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