An approach to the neonate with sudden dysrhythmia: diagnosis, mechanisms, and management

The clinical course of a newborn can be rendered more complex by the sudden development of a disturbance in heart rhythm and conduction. The caregiver's ability to recognize a particular dysrhythmia and its most probable mechanism is crucial for optimal management. During the past 15 years, there has been significant progress in the understanding of the electrophysiologic basis of rhythm disturbances in the newborn period. This understanding has led to more precise diagnosis and effective treatment regimens for infants with dysrhythmias. Using recent case studies from one intensive care nursery as illustrations, this article discusses the clinical presentation and electrophysiologic mechanisms of three common forms of rhythm and conduction disturbance. The discussion pertains to disturbances of rhythm in association with tachycardia only. Emphasis is placed on the electrocardiographic diagnosis and clinical management of these infants.