From the Research
For a 3-week-old infant with SVT, poor perfusion, and absent P waves with narrow complex, immediate treatment with vagal maneuvers or adenosine is essential to prevent cardiovascular collapse. The most recent and highest quality study 1 suggests that infants with SVT are at high risk for refractory SVT and hemodynamic compromise, making prompt recognition and treatment critical.
- First, attempt vagal maneuvers like applying an ice pack to the face for 10-15 seconds, as this method is safe, quick, and effective, especially in pediatric patients 2.
- If vagal maneuvers are unsuccessful, administer adenosine 0.1 mg/kg rapid IV push followed by saline flush; this can be increased to 0.2 mg/kg if needed (maximum 12 mg) 3.
- For persistent SVT with hemodynamic compromise, synchronized cardioversion at 0.5-1 J/kg should be performed 1.
- After acute conversion, maintenance therapy with propranolol (1-4 mg/kg/day divided every 6-8 hours) or digoxin may be needed.
- Ensure continuous cardiac monitoring, secure IV access, and have resuscitation equipment ready, as infants with SVT are at high risk for cardiovascular collapse due to their limited cardiac reserve 1. Key points to consider in the management of SVT in infants include:
- Prompt recognition and treatment to prevent deterioration to shock or cardiac arrest
- The use of vagal maneuvers as a first-line treatment due to their safety and effectiveness
- The importance of having resuscitation equipment ready and continuous cardiac monitoring in place
- The potential need for synchronized cardioversion in cases of hemodynamic compromise
- The role of maintenance therapy with antiarrhythmic medications after acute conversion.