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Medication

Medication Summary

The number of drugs that have been used for the correction of fetal arrhythmias reflects the amount of uncertainty about dosage, effectiveness, and hazards. Fetal pharmacokinetic studies are not available, and dosage schedules for these very immature infants are uncertain or derived from data on older and bigger infants and children. Thus, consider each case individually; be aware that therapeutic misadventures remain possible if not probable.

Class Summary

These are used for fetal cardiac failure. Positive inotropic agents (eg, digoxin) increase force of contraction of myocardium and are used to treat acute and chronic CHF. Digoxin may also be used for fetal supraventricular tachycardia (SVT) because it decreases AV conduction.

Digoxin (Lanoxin, Lanoxicaps)

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Recommended dosages require considerable modification because of individual variations in sensitivity to drug in adults, children, and (probably) fetuses. Usually administered to mother; thus, adult dosages are used. Transplacental transfer is normally excellent; however, impaired fetal perfusion of placental circulation due to severe cardiac failure results in impaired drug pickup; thus, fetal drug levels may be much lower than maternal concentrations.

Class Summary

These are used to treat fetal edema. They promote excretion of water and electrolytes by kidneys and are used to treat heart failure or hepatic, renal, or pulmonary disease when sodium and water retention has resulted in edema or ascites.

Furosemide (Lasix)

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Diuretic, in conjunction with digoxin, that has been used in management of fetal hydrops. Both transplacental (maternal administration) and direct fetal routes have been used. No satisfactory pharmacokinetic data are available to support these recommendations.

Class Summary

These agents alter electrophysiologic mechanisms responsible for arrhythmia and are used to treat fetal arrhythmia.

Verapamil (Calan, Calan SR, Covera-HS, Verelan)

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Anecdotal use.

Amiodarone (Cordarone)

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Limited use in fetus.

Adenosine (Adenocard)

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Recent use has been promising; however, most information is in form of case reports.

Procainamide (Procanbid, Pronestyl)

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Use in children well established; however, little data available on use in preterm neonate or fetus.

Sotalol (Betapace)

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Recent use in fetal arrhythmias has been promising; however, data are scarce, and definitive pharmacokinetic studies have not been performed.

Flecainide (Tambocor)

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Limited data from infants suggest that half-life at birth may be prolonged. These data have not been extended backward to fetal life. Maternal (transplacental) use, in conjunction with digoxin, has been promising anecdotally.

Follow-up

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Media Gallery

Chest radiograph revealing the presence of pleural effusion, severe edema, and bilateral chest tubes.
Chest and abdomen radiograph revealing the presence of severe edema and ascites.
Chest and abdomen radiograph revealing the presence of severe edema, pleural effusion, and bilateral chest tubes. An umbilical artery catheter, umbilical vein catheter, and endotracheal tube are in place.

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Author

Ashraf H Hamdan, MD, MBBCh, MSc, MRCP, FAAP Adjunct Associate Clinical Professor of Pediatrics, Vanderbilt University Medical Center; Neonatologist, Pediatrix Medical Group of Nashville

Ashraf H Hamdan, MD, MBBCh, MSc, MRCP, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Arun K Pramanik, MD, MBBS Professor of Pediatrics, Louisiana State University Health Sciences Center

Arun K Pramanik, MD, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, National Perinatal Association, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Dharmendra J Nimavat, MD, FAAP Associate Professor of Clinical Pediatrics, Department of Pediatrics, Division of Neonatology, Southern Illinois University School of Medicine; Staff Neonatologist, Clinical Director, NICU Regional Perinatal Center, HSHS St John's Children's Hospital

Dharmendra J Nimavat, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association of Physicians of Indian Origin

Disclosure: Nothing to disclose.

Additional Contributors

David N Sheftel, MD Assistant Professor of Pediatrics, Chicago Medical School at Rosalind Franklin University of Medicine and SciencE

David N Sheftel, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Pediatrics

Disclosure: Nothing to disclose.

Ted Rosenkrantz, MD Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine

Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Eastern Society for Pediatric Research, American Medical Association, Connecticut State Medical Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Drugs & Diseases gratefully acknowledge the contributions of previous author, George Cassady, MD, to the development and writing of this article.

Pediatric Hydrops Fetalis Medication

Medication Summary

Cardiac glycosides

Class Summary

Digoxin (Lanoxin, Lanoxicaps)

Digoxin (Lanoxin, Lanoxicaps)

Loop diuretics

Class Summary

Furosemide (Lasix)

Furosemide (Lasix)

Antiarrhythmic agents

Class Summary

Verapamil (Calan, Calan SR, Covera-HS, Verelan)

Verapamil (Calan, Calan SR, Covera-HS, Verelan)

Amiodarone (Cordarone)

Amiodarone (Cordarone)

Adenosine (Adenocard)

Adenosine (Adenocard)

Procainamide (Procanbid, Pronestyl)

Procainamide (Procanbid, Pronestyl)

Sotalol (Betapace)

Sotalol (Betapace)

Flecainide (Tambocor)

Flecainide (Tambocor)

Pediatric Hydrops Fetalis Medication

Medication Summary

Cardiac glycosides

Class Summary

Digoxin (Lanoxin, Lanoxicaps)

Loop diuretics

Class Summary

Furosemide (Lasix)

Antiarrhythmic agents

Class Summary

Verapamil (Calan, Calan SR, Covera-HS, Verelan)

Amiodarone (Cordarone)

Adenosine (Adenocard)

Procainamide (Procanbid, Pronestyl)

Sotalol (Betapace)

Flecainide (Tambocor)

References

Tables

Contributor Information and Disclosures

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