A varying presentation of refractory supra ventricular tachycardia in a newborn: A rare and unusual case report

Conduction abnormalities in neonates are not common and some arrhythmias may resolve spontaneously, while refractory abnormalities may persist. Some rare arrhythmias may be associated with congestive cardiac failure (CCF) or shock, requiring immediate intervention. Most supraventricular tachycardias (SVT) respond to adenosine and are rarely refractory. If not managed properly, it may result in more complications, prolonged hospital stays, and mortality. Here, we are reporting the case of a 20-day-old baby who presented with poor feeding, respiratory distress, lethargy, and tachycardia. The heart rate was at 248 beats per minute, and the electrocardiogram showed a narrow QRS complex arrhythmia. The baby was diagnosed with arrhythmia with CCF and was loaded with adenosine. The baby did not respond to increasing subsequent adenosine doses, so the baby needed an amiodarone infusion, digoxin therapy, and cardioversion. The baby was successfully managed and discharged on tablet propranolol and syrup digoxin, which were discontinued at subsequent visits. Refractory arrhythmias are not a rare phenomenon and can be seen in neonates too, so any baby, if not responding to conventional treatment and adenosine, must be treated with second-line antiarrhythmic drugs.