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Neonatal Arrhythmia

Neonatal Arrhythmia. Birth History. ARB Delivered via STAT Primary Cesarean Section for arrest in cervical dilatation 25 year old G1P1 (1001) AOG: 38 5/7 weeks MT: 39 AGA Apgar Score: 9,9 Anthropometrics: BW= 2890 grams BL= 47 cm HC= 35 cm CC= 32 cm AC= 27 cm.

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Neonatal Arrhythmia

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  1. Neonatal Arrhythmia

  2. Birth History • ARB • Delivered via STAT Primary Cesarean Section for arrest in cervical dilatation • 25 year old G1P1 (1001) • AOG: 38 5/7 weeks • MT: 39 AGA • Apgar Score: 9,9 • Anthropometrics: • BW= 2890 grams • BL= 47 cm • HC= 35 cm • CC= 32 cm • AC= 27 cm

  3. Maternal History: 1st Trimester, Cough and Colds, no medications given • Past Medical History: Breast cyst, Left, s/p Excision(2012) • Family History: Hypertension • OB History: present pregnancy • Personal Social: College graduate, housewife, no vices

  4. Upon Delivery • Good cry and activity, no cyanosis • Clear amniotic fluid • Flat and open fontanelles • Good air entry, no retractions • Irregular cardiac rhythm, HR 140 bpm, no murmur (skipped beats, 10 -13x per minute) • Soft Abdomen • Grossly normal female genitalia • Full pulses

  5. Initial Impression • Term Baby Girl • r/o Cardiac Pathology

  6. PLAN: • Transfer to Level 3 of care hook to cardiac monitor • Refer to a pediatric cardiologist • Hook to cardiac monitor • BP and oxygen saturations on all extremities

  7. Course in the NICU

  8. Stable vital signs • BP on all extremities: • Oxygen saturations on all extremities: 100%

  9. Course in the NICU

  10. 2D echo • PFO 4.2mm • Left to right shunt • Trivial mitral regurgitation • PDA 1.8 continuous blow • Normal transitional circulation; no arrhythmia • Cardiology remarks: • Common incidental finding in newborns • Structural abnormality ruled out • No signs of heart failure noted • Refer for >5 skipped beats per minute

  11. EG7 results: • Na: 138 mmo/L • K: 4.3 mmo/L • iCal: 1.21 mmo/L • Hct: 47% • pH: 7.37 • pCO2: 47 mmHg • pO2: 38mmHg (80-105) • HCO3: 27 mmo/L • TCO2: 28 mM • Beecf: 2 mM • sO2: 69% (95-98) • tHB: 16 g/dL

  12. Course in the NICU

  13. Course in the NICU

  14. Neonatal Arrhythmias • Arrhythmias in fetuses and newborns are relatively common -- up to 90% of newborns and 1% to 3% of pregnancies • Life-threatening arrhythmias are uncommon

  15. Almost all arrhythmias fall into one of three categories • irregular • tachycardic • bradycardic

  16. Arrhythmias are found in 1–5% of newborns during the first 10 days of life • Most are premature supraventricular beats that will disappear during the first month of life • The development of symptoms depends on the rate and duration of the arrhythmia • tachyarrhythmia - 240–300bpm • Bradyarrhythmia - <100bpm

  17. Normal Newborn ECG

  18. Sinus Pause

  19. Sinus Arrhythmia

  20. Sinus pauses from 800 to 1,000 msec may occur in healthy newborns • Such pauses usually are followed by escape beats from the atria or the atrioventricular (AV) junction • Pauses of more than 2 seconds are considered abnormal

  21. Possible causes: • oversedation, (drugs passed through the placenta) • hypothermia • central nervous system abnormalities • increased intracranial pressure • increased vagal tone • obstructive jaundice • hypothyroidism

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