[Atrioventricular block complicating the use of diphemanil (Prantal) in 2 premature newborn infants].
BACKGROUND
Diphemanil can be useful in some neonates presenting with bradycardia due to vagal hyperreflectivity. Paradoxically, this drug may induce atrio-ventricular (AV) block in premature babies.


METHODS
Case no 1. A premature neonate suffering from acute respiratory distress from birth required respiratory support, antibiotics and caffeine. Despite this treatment, he underwent many episodes of apnea, and bradycardia that appeared on day 4 and did not respond to IV doxapram (1 mg/kg/h). He was given diphemanil on day 9 (10 mg/kg/d) and permanent bradycardia with complete AV block and a normal QT interval appeared 2 days later. Cessation of diphemanil and administration of IV isoprenaline led to a normal sinusal rhythm, but there were bladder, intestinal and ocular signs of atropinic intoxication. A complete definitive recovery occurred 5 days after cessation of diphemanil. Case no 2. A premature neonate developed episodes of apnea 2 days after birth. These episodes persisted and were complicated by bradycardia on day 4 despite administration of caffeine. Vagal stimulation on day 7 was positive and the infant was then given diphemanil (10 mg/kg/d). Permanent bradycardia occurred 2 days later, with partial AV block and a normal QT interval. The child recovered a normal sinusal rhythm 2 days after cessation of diphemanil.


CONCLUSIONS
Anticholinergic therapy may cause permanent bradycardia due to AV block in premature infants. This therapy should not be given to premature infants without a prior ECG. Doses lower than those used in infants are recommended.
Bennasr
S
S
Service de Pharmacologie Clinique, Hôpital Robert-Debré, Paris.
Baumann
C
C
Casadevall
I
I
Bompard
Y
Y
Jacqz-Aigrain
E
E
D001919:Bradycardia / Q000188:drug therapy / Q000209:etiology; D001993:Bronchodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D006327:Heart Block / Q000139:chemically induced*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D010276:Parasympatholytics / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D010880:Piperidines / Q000009:adverse effects*; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications* / Q000628:therapy
D001993:Bronchodilator Agents; D010276:Parasympatholytics; D010880:Piperidines; C028209:diphemanil methylsulfate
Bloc auriculo-ventriculaire compliquant l'utilisation du diphémanil (Prantal) chez deux nouveau-nés prématurés.