Managing SVT attacks in NICU: A single tertiary center experience

Aim: This study aimed to assess the efficiency of adenosine and amiodarone in ceasing supraventricular tachycardia (SVT) attacks and enduring 1-hour attack-free period in neonates.

Materials and Methods: We included all SVT attacks detected in our NICU and recorded adenosine success in enduring 1-hour attack-free period, postnatal day, birth week, and clinical status. All patients underwent vagal maneuvers as the initial intervention; then, they were administered intravenous adenosine via a central line, the dose of which was increased from 0,05 mg/kg/dose up to 0.2 mg/kg/dose if the SVT attack persisted. We included each SVT attack separately. 

Results: We observed 21 SVT attacks (gestational age 39.8+/-2.3 weeks) in 10 patients. There was a significant correlation between adenosine success and the postnatal day for SVT attacks (Kendall’s tau b: 0.584, p=0.002). Multivariate analysis showed that the most effective confounder for adenosine success was the postnatal day [odds ratio 1.9 (%95 CI: 1.03-3.5) per day]. Intravenous amiodarone loading therapy aborted SVT attack in all adenosine-resistant patients.

Conclusion: Amiodarone infusion may be considered earlier in cases where there is a need for repeated adenosine, especially in the early neonatal period.