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[Atrioventricular block complicating the use of diphemanil (Prantal) in 2 premature newborn infants].

AbstractBACKGROUND:
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.
CASE REPORTS:
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.
AuthorsS Bennasr, C Baumann, I Casadevall, Y Bompard, E Jacqz-Aigrain
JournalArchives francaises de pediatrie (Arch Fr Pediatr) Vol. 50 Issue 5 Pg. 413-5 (May 1993) ISSN: 0003-9764 [Print] France
Vernacular TitleBloc auriculo-ventriculaire compliquant l'utilisation du diphémanil (Prantal) chez deux nouveau-nés prématurés.
PMID8239894 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Bronchodilator Agents
  • Parasympatholytics
  • Piperidines
  • diphemanil methylsulfate
Topics
  • Bradycardia (drug therapy, etiology)
  • Bronchodilator Agents (adverse effects, therapeutic use)
  • Drug Administration Schedule
  • Heart Block (chemically induced)
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Male
  • Parasympatholytics (administration & dosage, adverse effects, therapeutic use)
  • Piperidines (adverse effects)
  • Respiratory Distress Syndrome, Newborn (complications, therapy)

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