Neonatal Nurse Practitioner/Nurse Scientist Children's Hospital Colorado, Colorado, United States
Background: Supraventricular Tachycardia (SVT) is the most common symptomatic arrhythmia in the newborn period. The status of an infant experiencing SVT can be stable or unstable. The neonatal resuscitation program (NRP) is the most common algorithm used to guide care in infants. NRP does not provide guidance for SVT. The most common approach to treat SVT in infants is vagal maneuvers, when unsuccessful escalation to administration of adenosine. The Pediatric Advanced Life Support (PALS) algorithm provides guidance with an algorithm for tachycardia for unstable SVT. The PALS algorithm for tachycardia advises adenosine and cardioversion and differentiates between the management of stable and unstable SVT. In level IV NICUs there is a growing trend to incorporate PALS knowledge and training into the NICU. To understand the difference in current practice and adoption of PALS practice regarding treatment of SVT, the purpose of this study is to describe SVT in a level 4 NICU, use of adenosine and report outcomes of infants treated with adenosine. Objective: The goal of this study is to evaluate if the PALS algorithm was followed for these infants, would the recommended management of SVT have included cardioversion? Design/Methods: This was a retrospective single center observational study. Adenosine administrations were evaluated in a level IV NICU from January 1, 2018 – December 31, 2023 using the electronic medical record. Individual chart review extracted the additional variables. Criteria for cardioversion per the PALS algorithm were the following: hemodynamic instability (poor perfusion, hypotension or heart failure) with hypotension defined as: systolic BP < 60 in infants < 24 hours of life, and a systolic BP < 67 in infants >24hrs of life. Results: There were 98 episodes of adenosine administration across twenty-three unique infants. The range of adenosine dose/patient was 100-300mcg/kg/dose. A code was called for 2 episodes of SVT. Hypotension was present in 26% (n=26) episodes. Identifiable causes of SVT include: fetal or neonatal SVT (7), CDH (6), other cardiac (3), unknown (7). Ninty-one percent (n=21) of infants survived to discharge. 17 infants were discharged home on medication. Digoxin and Propranolol were the most common medications prescribed at discharge. Twenty-six percent of SVT events during this time period qualified for cardioversion under guidance from the PALS algorithm.
Conclusion(s): As NICU units adopt PALS guidelines and algorithms, careful consideration should be given to treatment of SVT. Units should determine clear criteria to define hemodynamic instability and use of cardioversion.
