1. Neonatal Arrhythmia

2. Birth History
ARB
Delivered via STAT Primary Cesarean Section for arrest in cervical dilatation
25 year old G1P1 (1001)
AOG: 38 5/7 weeks
MT: 39 AGA
Apgar Score: 9,9
Anthropometrics:
BW= 2890 grams
BL= 47 cm
HC= 35 cm
CC= 32 cm
AC= 27 cm

3. Maternal History: 1st Trimester, Cough and Colds, no medications given
Past Medical History: Breast cyst, Left, s/p Excision(2012)
Family History: Hypertension
OB History: present pregnancy
Personal Social: College graduate, housewife, no vices

4. Upon Delivery Good cry and activity, no cyanosis Clear amniotic fluid
Flat and open fontanelles
Good air entry, no retractions
Irregular cardiac rhythm, HR 140 bpm, no murmur (skipped beats, x per minute)
Soft Abdomen
Grossly normal female genitalia
Full pulses

5. Initial Impression
Term Baby Girl
r/o Cardiac Pathology

6. Transfer to Level 3 of care hook to cardiac monitor
PLAN:
Transfer to Level 3 of care hook to cardiac monitor
Refer to a pediatric cardiologist
Hook to cardiac monitor
BP and oxygen saturations on all extremities

7. Course in the NICU Subjective Objective Assessment Plan 3rd HOL
Good suck, cry, and activity
Able to latch
T: 36.8, HR 146, RR: 44
No cyanosis, no alar flaring
Good air entry, no retractions
Irregular cardiac rhythm, with 1-2 skipped beats/minute
Full pulses
Live term baby girl
r/o cardiac pathology
Monitor vital signs every hour
Hook to cardiac monitor
BP and O2 sats on all extremities
Watch out for skipped beats/minute

8. Oxygen saturations on all extremities: 100%
Stable vital signs
BP on all extremities:
Oxygen saturations on all extremities: 100%
61/31
63/38
65/30
61/35

9. Course in the NICU Subjective Objective Assessment Plan 10th HOL
Good suck, cry, and activity
Tolerates 10-15ml of milk feedings
T: 37, HR 122, RR: 44
No cyanosis, no alar flaring
Good air entry, no retractions
Irregular cardiac rhythm, with 2-5 skipped beats/minute
Full pulses
Live term baby girl
r/o cardiac patholog
Bed side 2D-echo
EG-7

10. 2D echo Cardiology remarks: PFO 4.2mm Left to right shunt
Trivial mitral regurgitation
PDA 1.8 continuous blow
Normal transitional circulation; no arrhythmia
Cardiology remarks:
Common incidental finding in newborns
Structural abnormality ruled out
No signs of heart failure noted
Refer for >5 skipped beats per minute

11. EG7 results: Na: 138 mmo/L K: 4.3 mmo/L iCal: 1.21 mmo/L Hct: 47%
pH: 7.37
pCO2: 47 mmHg
pO2: 38mmHg (80-105)
HCO3: 27 mmo/L
TCO2: 28 mM
Beecf: 2 mM
sO2: 69% (95-98)
tHB: 16 g/dL

12. Course in the NICU Subjective Objective Assessment Plan 24th HOL
Good suck, cry, and activity
Tolerates 10-15ml of milk feedings every 2 hours
T: 36,5, HR 148, RR: 56
No cyanosis, no alar flaring
Good air entry, no retractions
Regular cardiac rhythm, no skipped beats
Full pulses
Live term baby girl
Rooming in

13. Course in the NICU Subjective Objective Assessment Plan Day 2 of life
Good suck, cry, and activity
Breastfeeding
T: 36,5, HR 148, RR: 56
No cyanosis, no alar flaring
Good air entry, no retractions
Regular cardiac rhythm, no skipped beats
Full pulses
Live term baby girl
May go home
For ECG - Normal

14. Neonatal Arrhythmias
Arrhythmias in fetuses and newborns are relatively common -- up to 90% of newborns and 1% to 3% of pregnancies
Life-threatening arrhythmias are uncommon

15. Almost all arrhythmias fall into one of three categories
irregular
tachycardic
bradycardic

16. Arrhythmias are found in 1–5% of newborns during the first 10 days of life
Most are premature supraventricular beats that will disappear during the first month of life
The development of symptoms depends on the rate and duration of the arrhythmia
tachyarrhythmia - 240–300bpm
Bradyarrhythmia - <100bpm

17. Normal Newborn ECG

18. Sinus Pause

19. Sinus Arrhythmia

20. Sinus pauses from 800 to 1,000 msec may occur in healthy newborns
Such pauses usually are followed by escape beats from the atria or the atrioventricular (AV) junction
Pauses of more than 2 seconds are considered abnormal

21. Possible causes: oversedation, (drugs passed through the placenta)
hypothermia
central nervous system abnormalities
increased intracranial pressure
increased vagal tone
obstructive jaundice
hypothyroidism