CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 2, March/April 2014
58
AFRICA
Diagnosis, treatment and follow up of neonatal
arrhythmias
Fatih Köksal Binnetoğlu, Kadir Babaoğlu, Gülcan Türker, Gürkan Altun
Abstract
Objective:
This study aimed to evaluate the aetiology, spec-
trum, course and outcomes of neonates with arrhythmias
observed in a tertiary neonatal intensive care unit from 2007
to 2012.
Methods:
Neonates with rhythm problems were included.
The results of electrocardiography (ECG), Holter ECG, echo-
cardiography and biochemical analysis were evaluated. The
long-term results of follow up were reviewed.
Results:
Forty-five patients were male (68%) and 21 (32%)
were female. Fifty-five patients (83.3%) were term, 11
(16.6%) were preterm, and 34% were diagnosed in the prena-
tal period. Twenty cases (30.3%) had congenital heart disease.
Twenty-three patients (34.8%) were diagnosed during the
foetal period. The most common arrhythmias were supraven-
tricular ectopic beats and supraventricular tachycardia (SVT)
at 39.3 and 22.7%, respectively. SVT recurred in five patients
after the neonatal period.
Conclusion:
Supraventricular ectopic beats and SVT were
the most common arrhythmias during the neonatal period.
Although the prognosis of arrhythmias in the neonatal period
is relatively good, regular monitoring is required.
Keywords:
arrhythmia, neonatal, supraventricular tachycardia
Submitted 31/5/13, accepted 4/2/14
Cardiovasc J Afr
2014;
25
: 58–62
DOI: 10.5830/CVJA-2014-002
Arrhythmias are seldom observed in the newborn period and
rarely lead to serious consequences. The incidence is about 1%
during the neonatal period and 1–3% in late pregnancy.
1
Long-term tachycardia and bradycardia attacks induced by
neonatal arrhythmias may lead to heart failure and hydrops
foetalis.
2
Because they may be a continuation of foetal
arrhythmias, newborn arrhythmias are different from those
occurring at later ages.
3
For this reason, the early diagnosis of
arrhythmias in the prenatal period is essential for appropriate
and optimal treatment in the postnatal period. In this study, we
evaluated the type, clinical characteristics, treatment and follow
up of newborns with arrhythmias.
Methods
This study included 66 newborns (45 male, 21 female)
diagnosed with arrhythmia in a tertiary hospital between 2007
and 2012. In all cases, sex, birth method, birth weight, week
of pregnancy, maternal and gestational diseases, Apgar scores,
and haematological and biochemical parameters were recorded.
The results of electrocardiography (ECG) with 12 derivations,
24-hour Holter ECG and echocardiography were evaluated.
Type, course of arrhythmia, detection time and treatments were
analysed retrospectively.
The patients were divided into three groups: irregular heart
rhythm (ectopic beats, supraventricular premature beats and
ventricular premature beats), bradyarrhythmia [sinus bradycardia,
2:1 atrioventricular (AV) block, complete AV block, long QT
syndrome, etc], and tachyarrhythmias (sinus tachycardia,
supraventricular tachycardia, ventricular tachycardia). Benign
arrhythmias, such as sinus arrhythmia, nodal or junctional
rhythms, wandering atrial rhythm, first-degree AV block and
Wenckebach block were not included in the study.
The statistical analysis of the results was carried out using the
SPSS v13.0 (SPSS Inc., Chicago, IL, USA). Descriptive analyses
of the normal variables are given as mean and standard deviation;
data with non-normal distribution are given as minimum,
maximum and median values.
Results
Forty-five babies were male (68.2%) and 21 were female
(31.8%). The average duration of pregnancy was 38.1
±
2 weeks
(34–41), and the average birth weight was 3 258
±
508.6 g (2
200–4 500). Approximately 65% of the babies were delivered
by Caesarean section; 83.3% were term and 16.6% were preterm
(Table 1).
The initial clinical presentations were apnoea, poor feeding,
irritability, respiratory difficulties and cyanosis. Twenty-one
babies were asymptomatic and arrhythmia was diagnosed during
routine examination. Thirty patients had benign supraventricular
premature beats or ventricular premature beats. Eleven patients
had bradyarrhythmia and 25 had tachyarrhythmia (Table 2).
Twenty-three patients (34.8%) were diagnosed in the foetal
period. Six were premature and 17 were mature. Supraventricular
premature beat was the most frequently diagnosed arrhythmia in
the foetal period (Table 3). The mother of a baby with complete
heart block diagnosed in the foetal period had Sjogren’s disease.
Hydrops feotalis and foetal cardiomyopathy occurred in two
babies with foetal supraventricular tachycardia (SVT).
Medical Faculty, Çanakkale Onsekiz Mart University,
Çanakkale, Turkey
Fatih Köksal Binnetoğlu, MD,
Department of Paediatric Cardiology, Kocaeli University,
Kocaeli, Turkey
Kadir Babaoğlu, MD
Gürkan Altun, MD
Department of Neonatology, Kocaeli University, Kocaeli,
Turkey
Gülcan Türker, MD
