Development of an evidence-based guideline for neonatal unit management of supraventricular tachycardia

Abstract

Background: Supraventricular tachycardia (SVT) is the most common arrhythmia requiring treatment in neonates, but there are no published evidence-based guidelines for management in neonatal units. Methods: A search was conducted of journal articles, textbooks and hospital guidelines. We also conducted two systematic reviews addressing drug regimens for neonatal SVT due to atrioventricular re-entry or atrioventricular nodal re-entry: (1) the acute treatment for failure to respond or recurrence after vagal manoeuvres or adenosine and (2) the preventative antiarrhythmic to use on discharge. Results: Systematic review identified for the first question, one randomised trial comparing different doses of amiodarone, which found higher doses were more efficacious but a high risk of adverse events. For the second question, we found one randomised trial and three observational studies yielding low quality evidence of no difference between propranolol and digoxin for the prevention of SVT recurrence. Conclusions: We developed a comprehensive guideline for assessment and management of the common forms of neonatal SVT. Limited published evidence supports current expert cardiologist opinion favouring beta blockers for the inpatient treatment of recurrent SVT and either beta blockers or digoxin for postdischarge prophylaxis.L6271924762019-04-18 <br />