Vagal bradycardia at term.
We discuss the case of a newborn boy presenting well into term with severe bradycardic events and sinus pauses up to 5.4 sec. Sinus bradycardia below 80 bpm and sinus pauses or asystole of more than 2 sec are considered pathologic at term. After exclusion of specific causes, the diagnosis of vagal hyper-reflectivity (VHR) was retained, a state caused by unbalance between sympathetic and parasympathetic activity, the latter overriding the former. It is thought to be a functional and transitional anomaly of the sympathetic and vagal tone during the first months of life and may lead to prolonged monitoring and delayed hospital discharge. This form of rare bradycardia can be treated with atropine and allowed in our case immediate resolution of events and safe discharge from hospital.


CONCLUSIONS
When VHR is diagnosed, atropine is the treatment permitting resolution of symptomatic episodes of bradycardia and early and safe discharge from hospital.
Delcò
Cristina
C
Department of the Child and Adolescent, University Hospital of Geneva and Geneva University, Switzerland.
Beghetti
Maurice
M
Pfister
Riccardo E
RE
D001285:Atropine / Q000627:therapeutic use; D001919:Bradycardia / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D010276:Parasympatholytics / Q000627:therapeutic use
D010276:Parasympatholytics; D001285:Atropine