Supraventricular Tachycardia in Infants With Congenital Diaphragmatic Hernia: Prevalence, Associations, and Outcomes.

Autor:	Tella JB; Department of Cardiology, Boston Children's Hospital, Boston, MA., Dao DT; Department of Surgery, Boston Children's Hospital, Boston, MA., Alexander ME; Department of Cardiology, Boston Children's Hospital, Boston, MA.; Harvard Medical School, Boston, MA., Geva A; Harvard Medical School, Boston, MA.; Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA., Vitali SH; Harvard Medical School, Boston, MA.; Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA., Zalieckas JM; Department of Surgery, Boston Children's Hospital, Boston, MA.; Harvard Medical School, Boston, MA., Mehta NM; Harvard Medical School, Boston, MA.; Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA., McManus ML; Harvard Medical School, Boston, MA.; Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA., Buchmiller TL; Department of Surgery, Boston Children's Hospital, Boston, MA.; Harvard Medical School, Boston, MA., Mullen MP; Department of Cardiology, Boston Children's Hospital, Boston, MA.; Harvard Medical School, Boston, MA.
Jazyk:	angličtina
Zdroj:	Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies [Pediatr Crit Care Med] 2022 Jul 01; Vol. 23 (7), pp. e329-e337. Date of Electronic Publication: 2022 Mar 30.
DOI:	10.1097/PCC.0000000000002952
Abstrakt:	Objectives: To characterize the prevalence, associations, management, and outcomes of supraventricular tachycardia (SVT) in neonates with congenital diaphragmatic hernia (CDH). Design: Retrospective chart and cardiology code review within a cohort of patients with CDH was used to define a subpopulation with atrial arrhythmia. SVT mechanisms were confirmed by electrocardiogram analysis. Cox proportional hazard regression identified risk factors for SVT and association with clinical outcomes. Setting: Medical Surgical ICU in a single, tertiary center, Boston Children's Hospital. Patients: Eligible patients included neonates presenting with classic Bochdalek posterolateral CDH between 2005 and 2017, excluding newborns with Morgagni hernia or late diagnoses of CDH (>28 d). Interventions: None. Measurements and Main Results: SVT arose in 25 of 232 neonates with CDH, (11%); 14 of 25 infants (56%) had recurrent SVT; atrioventricular node-dependent tachycardia was the most frequent mechanism (32%). The majority (71%) of SVT episodes received intervention. Nine patients (36%) received preventative antiarrhythmic medications. SVT was associated with lower Apgar score at 1 min, structural heart disease, larger defect size, extracorporeal membrane oxygenation (ECMO) support, and prostaglandin therapy for ductal patency as well as hospital stay greater than or equal to 8 weeks and use of supplemental oxygen at discharge. Conclusions: SVT can occur in neonates with CDH and frequently requires treatment. Odds of occurrence are increased with greater CDH disease severity, ECMO, and prostaglandin use. In unadjusted logistic regression analysis, SVT was associated with adverse hospital outcomes, underscoring the importance of recognition and management in this vulnerable population. Competing Interests: Dr. Dao received support for article research from the National Institutes of Health. Dr. Alexander disclosed the off-label product use of pediatric antiarrhythmia therapy and, in particular, infant antiarrhythmia therapy. Dr. Zalieckas received funding from Takeda Pharmaceutical. Dr. Mullen disclosed the off-label product use of Procainamide, Flecainide, Propranolol, Amiodarone, and Esmolol in pediatric age range. Dr. Mullen received funding from Altavant Sciences Pediatric for PAH Scientific Advisory Board and from Up to Date. Dr. Alexander received funding from Up to Date. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)
Databáze:	MEDLINE
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