Neonatal arrhythmia: 8-year results of the single center experience

Aim: Although neonatal arrhythmias are rare in the neonatal period, they cause mortality and morbidity by progressing with different clinical conditions. Arrhythmia can be seen between 1-5% in the neonatal period. Neonatal arrhythmias usually occur as a continuation of arrhythmias in the fetal period. Therefore, prenatal diagnosis is important for early diagnosis and treatment of neonatal arrhythmias. However, the exact frequency and types of arrhythmias in the neonatal intensive care unit are unknown. It is also not entirely clear whether different medical conditions, interventions, and medications administered to these sick infants may predispose to arrhythmias. In this study, it is aimed to determine the accompanying cardiac or systemic diseases as well as the demographic data of infants admitted to the neonatal intensive care unit for arrhythmia or diagnosed with arrhythmia during hospitalization. The clinical and demographic characteristics, electrocardiographic and echocardiographic findings of the patients will be examined and the most common arrhythmia types and their response to treatment will be compared. Material and method: The population of this study consisted of patients diagnosed with arrhythmia in the antenatal and neonatal period, who were hospitalized in the Neonatal Intensive Care Unit of Dicle University Medical Faculty Hospital between January 1, 2014 and December 31, 2021. In our study, the files of 42 patients who were admitted to the neonatal intensive care unit with the diagnosis of arrhythmia in the antenatal and neonatal period or who were found to have cardiac arrhythmia during their neonatal hospitalization were reviewed retrospectively. History, physical examination, ECG, echocardiography, Holter monitoring records, if any, of the patients were reviewed. Postnatal age, gender, gestational week, maternal disease and drug use histories, admission complaints and hospitalization diagnoses, concomitant cardiac and non-cardiac diseases, arrhythmia type, treatments applied, treatment responses, length of stay and post-discharge treatment needs of all patients on the day of admission to the hospital were evaluated. It was recorded whether she received oxygen therapy, mechanical ventilation, total parenteral nutrition, transfusion and inotropic therapy. Results: 42 patients were included in the study. It was determined that 54.4% of the patients in the study were male (n=22), 47.6% were female (n=20). The mean gestational week was 36.83 weeks and the mean birth weight was 2930 grams. The mean age at presentation of the patients was 4 days. When the ECO findings of 40 out of 42 patients were examined in our study, the ECHO of 11 patients (27.5%) was evaluated as normal. The most common pathological ECHO findings in our study were: Patent Foramen Ovale (PFO) in 11 patients (27.5%), Atrial Septal Defect (ASD) in 9 patients (22.5%), Patent Ductus Arteriosus in 7 patients (17.5%). (PDA) and Ventricular Septal Defect (VSD) were detected in 2 patients (5%). A solitary arrhythmia was observed in 36 of the patients. Of these; 11 (26.19%) SVT, 6 (14.28%) LQTS, 4 (9.5%) VT, 3 (7.14%) 1st degree AV block, 3' Sinus tachycardia was present in 3 (7.14%), fetal arrhythmia in 2 (4.76%), VES in 2 (4.76%), WPW in 2 (4.76%), 2 (4%) ,76) atrial flutter and 1 (2.38%) sinus bradycardia (2.38%) were found. In our study, more than one arrhythmia was observed in 6 patients. Sinus bradycardia -LQTS was found in 3 (7.14%) of these patients, sinus tachycardia-LQTS in 1 (2.38%) and fetal arrhythmia - LQTS in 1 (2.38%) of these patients. Antiarrhythmic treatment was given to 24 of the patients (57.14%) in the hospital. 8 of the patients were treated with propranolol, 7 of them adenosine + amidarone + propranolol, 3 of them amidarone + propranolol, 3 of them adenosine + amidarone + propranolol + cardioversion, 2 of them adenosine and 1 of them adenosine + digoxin + propranolol + amiodarone has been applied. It was determined that 26 (61.9%) of the patients were not given any treatment at home, and 16 (38.1%) of them were given antiarrhythmic treatment at home. It was determined that all patients with SVT were given home treatment, the most preferred antiarrhythmic treatment was propranolol, and other agents were amiodarone and digoxin. In our study, the mean hospital stay of the patients was 13 days. Conclusion: Although neonatal arrhythmias are rarely seen in neonatal intensive care units, they may occur as a result of various cardiovascular, systemic and metabolic problems. In the neonatal period, arrhythmia can be seen between 1-5%. Neonatal arrhythmias usually occur as a continuation of arrhythmias in the fetal period. Neonatal arrhythmias usually occur as a continuation of arrhythmias in the fetal period. Therefore, prenatal diagnosis is important for early diagnosis and treatment of neonatal arrhythmias. Appropriate and timely treatment is life-saving in most cases in the long run. Keywords: Neonatal, arrhythmia, neonatal intensive care.