Supraventricular Tachycardia in a Term Neonate

Presentation

A 13-day-old term neonate presents after an episode of altered consciousness and color change at home. He was in his normal state of health when his mother fed him 4 oz of human milk, burped him, and then he started crying. He was inconsolable for 2 minutes, then his skin turned white then gray-blue; he was sweating, his heartrate felt fast to palpation, and he went quiet. His parents were able to wake him repeatedly, but he would not keep his eyes open. They deny apnea. Paramedics arrived 5 minutes later and provided oxygen by nasal cannula, at which point his color returned to normal and he was taken to a local emergency department. In the emergency department, supraventricular tachycardia (SVT) was noted on the monitor at a rate of 300 beats/min. He converted to sinus rhythm when an ice pack was applied to his face. He then transferred to our tertiary care center for further care. Upon evaluation at our center, parents state that he has returned to his baseline. He has no recent illnesses and has been feeding well per parents. He feeds 4 oz in 30 minutes with no associated dyspnea or diaphoresis. Parents deny previous episodes of cyanosis. His mother received standard prenatal care during the pregnancy, and he was born at 39 weeks’ gestation via normal spontaneous vaginal delivery without complication. His medical history is remarkable only for a 3-day stay in the NICU for transient tachypnea of the newborn in the immediate postnatal period, although his parents endorse persistent rapid breathing since discharge. He passed a pulse oximetry screen for critical congenital heart disease …