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European Journal of Pediatrics
Erschienen in: European Journal of Pediatrics 2/2016

01.02.2016 | Review

Evaluation and management of bradycardia in neonates and children

verfasst von: Alban-Elouen Baruteau, James C. Perry, Shubhayan Sanatani, Minoru Horie, Anne M. Dubin

Erschienen in: European Journal of Pediatrics | Ausgabe 2/2016

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Abstract

Heart rate is commonly used in pediatric early warning scores. Age-related changes in the anatomy and physiology of infants and children produce normal ranges for electrocardiogram features that differ from adults and vary with age. Bradycardia is defined as a heart rate below the lowest normal value for age. Pediatric bradycardia most commonly manifests as sinus bradycardia, junctional bradycardia, or atrioventricular block. As a result of several different etiologies, it may occur in an entirely structurally normal heart or in association with concomitant congenital heart disease. Genetic variants in multiple genes have been described to date in the pathogenesis of inherited sinus node dysfunction or progressive cardiac conduction disorders. Management and eventual prognosis of bradycardia in the young are entirely dependent upon the underlying cause. Reasons to intervene for bradycardia are the association of related symptoms and/or the downstream risk of heart failure or pause-dependent tachyarrhythmia. The simplest aspect of severe bradycardia management is reflected in the Pediatric and Advanced Life Support (PALS) guidelines.
Conclusion: Early diagnosis and appropriate management are critical in many cases in order to prevent sudden death, and this review critically assesses our current practice for evaluation and management of bradycardia in neonates and children.
What is Known:
• Bradycardia is defined as a heart rate below the lowest normal value for age. Age related changes in the anatomy and physiology of infants and children produce normal ranges for electrocardiogram features that differ from adults and vary with age.
• Pediatric bradycardia most commonly manifests as sinus bradycardia, junctional bradycardia, or atrioventricular block.
What is New:
• Management and eventual prognosis of bradycardia in the young are entirely dependent upon the underlying cause. Bradycardia may occur in a structurally normal heart or in association with congenital heart disease. Genetic variants in multiple genes have been described.
• Reasons to intervene for bradycardia are the association of related symptoms and/or the downstream risk of heart failure or pause-dependent tachyarrhythmia. Early diagnosis and appropriate management are critical in order to prevent sudden death.
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Metadaten
Titel
Evaluation and management of bradycardia in neonates and children
verfasst von
Alban-Elouen Baruteau
James C. Perry
Shubhayan Sanatani
Minoru Horie
Anne M. Dubin
Publikationsdatum
01.02.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Pediatrics / Ausgabe 2/2016
Print ISSN: 0340-6199
Elektronische ISSN: 1432-1076
DOI
https://doi.org/10.1007/s00431-015-2689-z

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