Abstract
Current recommendations for the administration of Digoxin (DIG) to low birthweight (LBW) infants are ill defined. We report the frequent occurrence of DIG toxicity in LBW infants treated with low dose maintenance DIG: 10 μg/kg/da without an initial loading dose. DIG was administered parenterally within the first 10 days of life to 34 infants <2500 gm with signs of congestive heart failure and patent ductus arteriosus. Ten of 34 (29.4%) developed DIG toxicity diagnosed on the basis of cardiac arrhythmias, ileus, abdominal distension and/or serum DIG levels >2.0 ng/dl (range 2.1-6.1). Sixteen of the 34 were 1500-2500 gm; 2/16 (12.5%) developed signs and symptoms of DIG toxicity and had elevated serum levels. Eighteen of the 34 infants were <1500 gm with 8/18 (44.4%) becoming DIG toxic. Two infants <1500 gm died; both had toxic serum levels at the time of death and 1 died of unexplained cardiac arrhythmias. All 10 DIG toxic infants had PR intervals >.12 sec (range .13 - .18) at the time of diagnosis without evidence of electrolyte imbalance, liver or renal compromise.
We conclude that LBW infants, especially those <1500 gm, are exquisitely sensitive to DIG even at low maintenance dosage. Prolongation of PR interval was indicative of DIG toxicity in our patients. Continuous monitoring of the PR intervals and serial serum DIG levels are recommended for the avoidance of serious complications of DIG therapy in LBW infants.
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Desai, N., Pauly, T., Johnson, G. et al. 97 DIGOXIN TOXICITY ASSOCIATED WITH LOW DOSAGE MAINTENANCE THERAPY IN PREMATURE INFANTS. Pediatr Res 12 (Suppl 4), 380 (1978). https://doi.org/10.1203/00006450-197804001-00102
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DOI: https://doi.org/10.1203/00006450-197804001-00102