Urgent permanent pacemaker implantation in critically ill preterm infants

Area of Science:

• Neonatal cardiology
• Pediatric electrophysiology
• Congenital heart disease

Background:

• Complete heart block in premature infants presents significant management challenges.
• Hydrops fetalis complicates the prognosis and treatment of neonatal complete heart block.
• Low birth weight (<2500g) in neonates with complete heart block requires specialized care.

Observation:

• Two premature infants, one with hydrops fetalis, experienced complete heart block.
• Birth weights were 1,400 grams and 1,000 grams, indicating very low birth weight.
• Emergent implantation of permanent epicardial pacemakers was performed within 48 hours of life.

Findings:

• Successful emergent implantation of permanent epicardial pacemakers in extremely premature infants.
• Pacemaker implantation was technically feasible and achieved in the early neonatal period.
• This approach addresses life-threatening bradycardia in this vulnerable population.

Implications:

• Early pacemaker implantation can be a viable strategy for managing complete heart block in extremely low birth-weight infants.
• This case series suggests that permanent epicardial pacing can be safely performed in neonates, even with hydrops fetalis.
• Further research is warranted to establish long-term outcomes and optimize management protocols for neonatal complete heart block.