Abstract

Background

Neonatal sepsis is a major cause of morbidity and mortality in preterm infants. Chorioamnionitis is an important risk factor for the development of sepsis, therefore neonates born to mothers developing signs of amnionitis need to be treated with antibiotics immediately after birth. Ureaplasma spp can be a causative agent of vaginal or intra amniotic infection needing antibiotic treatment. Macrolides are frequently used to treat maternal intrauterine infection, but antibiotic treatment of the neonate should be consciously chosen with consideration of potential side effects. Indeed, macrolides are great purveyors of heart rhythm disorders.

Case presentation

We describe the case of a 29 weeks preterm infant born to a mother with Ureaplasma spp infection. The baby was treated with erythromycin immediately after birth. During the second day of life, the baby presented some episodes of tachyarrhythmia with premature ventricular beats (PVBs) that were followed by a non-sustained ventricular tachycardia as high as 270 bpm leading to a cardiac arrest. After resuscitation, tachycardia resolved but the rhythm was characterised by numerous PVBs and an electrocardiogram (ECG) diagnosed a Long QT Syndrome (LQTS). Erythromycin was discontinued, and the rhythm normalised a few days after withdrawal.

Conclusions

Erythromycin should be administered in neonates only if no other choice is available, as although generally well tolerated, its administration can be associated with QTc interval prolongation. When no other option is available, paediatricians should be aware to perform cardiac monitoring or at least serial ECGs before and during erythromycin administration.

中文翻译：

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早产儿红霉素给药后 QT 间期延长导致的尖端扭转型室性心动过速

摘要

背景

新生儿败血症是早产儿发病率和死亡率的主要原因。绒毛膜羊膜炎是发生败血症的重要危险因素，因此出现羊膜炎迹象的母亲所生的新生儿需要在出生后立即接受抗生素治疗。脲原体属可能是需要抗生素治疗的阴道或羊膜腔内感染的病原体。大环内酯类药物常用于治疗产妇宫内感染，但应有意识地选择新生儿抗生素治疗，并考虑到潜在的副作用。事实上，大环内酯类药物是心律失常的重要源头。

案例展示

我们描述了一个 29 周早产婴儿的案例，该婴儿的母亲患有解脲支原体感染。婴儿出生后立即接受了红霉素治疗。在生命的第二天，婴儿出现了一些室性早搏 (PVB) 的快速性心律失常发作，随后出现高达 270 bpm 的非持续性室性心动过速，导致心脏骤停。复苏后，心动过速得到解决，但节律的特征是大量 PVB，心电图 (ECG) 诊断为长 QT 综合征 (LQTS)。停用红霉素，停药几天后心律恢复正常。

结论

只有在没有其他选择的情况下，才应在新生儿中使用红霉素，因为尽管通常耐受性良好，但其使用可能与 QTc 间期延长有​​关。当没有其他选择时，儿科医生应该注意在红霉素给药前和给药期间进行心脏监测或至少系列心电图检查。