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Effects of digoxin in infants with a congested circulatory state due to a ventricular septal defect
Insights
Digoxin therapy for infants with ventricular septal defects and circulatory congestion shows variable results. Some infants benefit clinically, even without a measurable inotropic response.
Area of Science:
- Pediatric Cardiology
- Pharmacology
Background:
- Congestive heart failure in infants often requires medical management.
- Ventricular septal defects (VSDs) can lead to significant circulatory congestion in neonates and infants.
Purpose of the Study:
- To evaluate the efficacy of digoxin in treating congested circulatory states in infants with VSD.
- To assess the relationship between digoxin's pharmacokinetic profile, inotropic response, and clinical benefit in this population.
Main Methods:
- Twenty-one infants with VSD and circulatory congestion were treated with digoxin.
- Dosing was guided by pharmacokinetic principles to achieve a target serum concentration.
- Echocardiography was used to assess inotropic response, and clinical benefit was monitored.
Main Results:
- Digoxin treatment led to a significant reduction in red-cell sodium-potassium ATPase levels.
- Only 6 out of 21 infants demonstrated an inotropic response via echocardiography.
- Clinical benefit was observed in 12 infants, including those with an inotropic response.
Conclusions:
- Digoxin therapy is not universally beneficial for all infants with VSD-related circulatory congestion.
- Clinical improvement can occur in some infants despite the absence of a measurable inotropic effect.
- Individualized pharmacokinetic-guided dosing may be necessary for optimizing digoxin therapy in infants.
Abstract:
Digoxin alone was used to treat a congested circulatory state in 21 infants (mean age, 2.7 months; mean weight, 3.8 kg) with a ventricular septal defect. The dose was adjusted on the basis of pharmacokinetics to achieve a mean steady-state concentration of 1.6 +/- 0.3 ng of digoxin per milliliter of serum. The mean red-cell level of sodium-potassium ATPase fell from 23.1 +/- 7.0 to 12.6 +/- 5.2 nmol per milligram per minute with treatment. Only 6 of the 21 patients had an inotropic response, as reflected by echocardiographic measurements, but the drug was of clinical benefit to 12 infants (including these 6). These results show that not all infants with a congested circulatory state due to a ventricular septal defect benefit from digoxin therapy. Furthermore, in some subjects clinical improvement occurs in the absence of a measurable inotropic response.