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Preterm infants with paroxysmal supraventricular tachycardia: presentation, response to therapy, and outcome
L E Goldman1, N K Boramanand, V Acevedo
1Department of Pediatrics, Yale University School of Medicine, USA.
Insights
Preterm infants with paroxysmal supraventricular tachycardia (PSVT) experience similar symptom severity but require fewer medications and have fewer recurrences than term infants. Preterm infants did not present with Wolff-Parkinson-White syndrome (WPW), unlike term infants.
Area of Science:
- Neonatal Cardiology
- Pediatric Electrophysiology
- Infant Arrhythmia Management
Background:
- Paroxysmal supraventricular tachycardia (PSVT) is the most common childhood arrhythmia, posing significant risks in infants.
- Limited data exists on the clinical course of PSVT specifically in preterm infants.
Purpose of the Study:
- To compare the clinical presentation, treatment response, and outcomes of PSVT in preterm versus term infants.
- To identify factors influencing the clinical course of PSVT in this population.
Main Methods:
- Retrospective chart review of 40 infants (<3 months) with PSVT (14 preterm, 26 term) from 1990-1999.
- Comparison of symptomatic severity, medication trials, recurrence rates, and presence of Wolff-Parkinson-White syndrome (WPW).
Main Results:
- Preterm and term infants showed similar symptomatic severity at presentation.
- Preterm infants required fewer medication trials (p=0.01) and had no recurrences post-discharge (vs. 43% in term infants, p<0.0001).
- Wolff-Parkinson-White syndrome (WPW) was absent in preterm infants but present in 42% of term infants (p=0.003), correlating with increased symptoms and medication needs in term infants with WPW.
Conclusions:
- Preterm infants with PSVT present with similar severity but have a more favorable clinical course, needing fewer medications and experiencing fewer recurrences than term infants.
- The absence of WPW in preterm infants may explain these observed differences in clinical outcomes.
Objectives:
We investigated the clinical course of preterm infants with paroxysmal supraventricular tachycardia in comparison to their term counterparts.
Background:
Paroxysmal supraventricular tachycardia (PSVT) is the most common arrhythmia in childhood. It is known to cause significant morbidity and rarely mortality, most commonly in infants. Yet, there is minimal information in the literature on preterm infants with PSVT.
Methods:
Retrospective review of 40 infants, 26 term and 14 preterm, less than three months of age who presented with PSVT from January 1990 to January 1999. We compared the severity of first clinical presentation, in-hospital response to long-term medications, and outcome after discharge.
Results:
Symptomatic severity on presentation was not different between preterm and term infants. Preterm infants required fewer medication trials (p=0.01) and had no recurrences after discharge in contrast with 43 % recurrence in the term infants (p<0.0001). No preterm infants had Wolff-Parkinson-White syndrome (WPW) in contrast to 42 % of term infants (p=0.003). Term infants with WPW were more symptomatic (p=0.01), required more medications (p=0.004), but had a similar recurrence frequency as terms infants without WPW (p=0.95). Excluding infants with WPW, preterm infants were more severely symptomatic (p=0.02), yet no longer was there a difference in response to first medication trial (p=0.30).
Conclusions:
We found that preterm infants with PSVT are as severely symptomatic on presentation, require fewer medications for adequate in-hospital control, and have fewer recurrences than their term counterparts. Unexpectedly, preterm infants did not present with WPW. The presence of WPW only in the term infants may account for differences in the clinical course between preterm and term infants.