QT interval prolongation and risk of life-threatening arrhythmias during toxoplasmosis prophylaxis with spiramycin in neonates.

We recently reported two cases of QT interval prolongation and cardiac arrest in newborns receiving antibiotic therapy with spiramycin, a macrolide agent extensively used for toxoplasmosis prophylaxis. In this study we assessed the effects of this drug on ventricular repolarization and on the potential risk of lethal arrhythmias in eight newborn infants in whom toxoplasmosis prophylaxis after birth was necessary. Electrocardiograms (ECGs) and echocardiograms were recorded during spiramycin therapy (350,000 i.u./kg/ day) and after its withdrawal. In a control group of eight healthy newborns matched for age and sex, no differences were found between two ECGs analogously recorded. The QT interval corrected for heart rate (QTc) was longer during spiramycin therapy than after drug withdrawal (448 +/- 32 msec vs 412 +/- 10 msec, +9%, p = 0.021). QTc dispersion, expressed as the difference between the longest and the shortest value in 12 different leads (QTcmax-min), was also higher during spiramycin therapy (60 +/- 32 msec vs 34 +/- 8 msec, +76%, p = 0.021), mainly because of a major lengthening of the longest QTc (QTcmax). QTc and QTc dispersion were markedly increased in the two newborns who experienced cardiac arrest after beginning treatment compared with the six neonates who had no drug-induced symptoms. During therapy seven of eight newborns had a rare abnormality in the thickening of the left ventricular posterior wall similar to that observed in patients with congenital long QT syndrome. This abnormality disappeared after drug withdrawal. Thus antibiotic therapy with spiramycin in the neonatal period may induce QT interval prolongation and increase QT dispersion. When this effect on ventricular repolarization is more marked, it may favor the occurrence of torsades des pointes and lead to cardiac arrest.

[Urokinase in a premature infant: its use in a case of right atrial thrombosis secondary to catheterization of the umbilical vein]. / Urochinasi nel prematuro: utilizzo in un caso di trombosi atrial destra secondaria a cateterizzazione della vena ombelicale.

Newborns with vascular catheters must be investigated by echocardiogram for intracardiac thrombosis. We report the use of urokinase to treat an asymptomatic right atrial thrombus in a 31 weeks' gestation newborn; the thrombosis occurred after placement of a catheter in the umbilical vein. We obtained a safe and successful thrombolysis using urokinase 4000 U/kg/h in continuous infusion.

[Longitudinal study of a group of 56 infants with a birth weight of less than 1500 gms: mortality and neurological sequelae in relation to progress in intensive care technics]. / Studio longitudinale di un gruppo di 56 bambini con peso alla nascita less than or equal to 1500 grammi: mortalità e sequele neurologiche in relazione ai progressi nelle tecniche di terapia intensiva.

56 very low-birth-weight (less than or equal to 1500 gm) infants were admitted in our Neonatal Intensive Care Unit between january 1978 and december 1981. Mortality of these infants in the first year of life decreased from 50% in 1978 to 32% in 1981. Our study confirms that mortality is significantly higher in transported infants. As to those born in our Hospital, mortality is markedly higher for breech delivery than for cephalic delivery or caesarian section. The amelioration of intensive care techniques, i.e. continuous transcutaneous PaO2 monitoring, orotracheal intubation at birth and improved respiratory care, markedly reduced the percentage of children with neuromotor pathology (from 43% in 1978 to 0% in 1981 in 16 survivors). Neurological follow-up was performed by serial controls until at least 2 years of age; Apgar scores and blood gas values are reported along with follow-up results to evaluate prognostic significance. Duration of orotracheal intubation, isolette requirement and feeding schedules are briefly discussed.