Multiple drugs
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Bradycardia and lack of efficacy: case report A male neonate [exact age not stated] exhibited lack of efficacy during treatment with adenosine-triphosphate, digoxin and disopyramide for multifocal atrial tachycardia. Subsequently, he developed bradycardia during treatment with aprindine for multifocal atrial tachycardia. The neonate’s mother presented to the hospital at 33 weeks of pregnancy with foetal tachycardia. Subsequently, she was diagnosed with foetal atrial flutter. Hence, she started receiving treatment with digoxin during her pregnancy. However, foetal tachycardia had sustained. On hospitalisation day 7, pleural effusion and transient foetal bradycardia were noted. Therefore, she underwent an urgent caesarean section, and delivered a male neonate with birth weight of 2400g and an apgar scores at 1 minute and 5 minutes were 8. The neonate’s HR was more than 200 beats/minute, BP was 25/18 mmHg and respiratory rate was 90 breaths/minute. He had retractive breathing. His chest x ray revealed symmetrical opacification of the lung field. Upon further investigation, he was diagnosed with atrial flutter with 2:1 conduction. He underwent electrical defibrillation due to hypotension. Forty hours after his birth, he again developed tachycardia. Therefore, IV adenosine-triphosphate 0.1 mg/kg injections and IV digoxin 0.004 mg/kg injections were given and electrical defibrillation was also carried out. However, the treatment with adenosinetriphosphate and digoxin showed no effect. He underwent re-examined 52 hours after his birth that showed 3 types of P waves and multifocal atrial tachycardia was diagnosed. Hence, IV digoxin 0.004 mg/kg every day and IV disopyramide 1 mg/kg were administered; however, they were found ineffective at 54 hours after his birth. Subsequently, he was treated with oral aprindine 1.5 mg/kg every day after 3 hours and his sinus rhythm has restored. But, he developed occasional bradycardia [duration of treatment to reaction onset not stated]. Hence, the neonate’s dose of aprindine was decreased. Eventually, his bradycardia had resolved and he was discharged on hospitalisation day 26 without recurrence of tachycardia or bradycardia. Koroki M, et al. Treatment of multifocal atrial tachycardia with aprindine. Pediatrics International 62: 869-870, No. 7, Jul 2020. Available from: URL: http://doi.org/10.1111/ 803500265 ped.14204
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Reactions 12 Sep 2020 No. 1821
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