Background Supra-Ventricular Tachycardia (SVT) is the commonest pathological tachycardia in newborns. West Midlands hospitals generally rely on the Advanced Paediatric Life Support (APLS) guideline to manage Neonatal SVT. This guideline is not neonate specific and Neonatal advanced nurse practitioners are not APLS trained.
Aim On behalf of the West Midlands Children’s Cardiac Network, we designed a survey to explore local practices, understand the dilemmas faced with neonatal SVT, as well as to determine the acceptability of a neonatal SVT guideline.
Methods An online questionnaire was designed using a survey programme, incorporating 10 questions on aspects of neonatal SVT and local practices, and this was sent out via email to all paediatric and neonatal consultants in the region and results collated using the survey software.
Results There were 43 responses, of which 74% were paediatricians, 19% neonatologists and the remainder PEC’s. Responses covered 80% of regional trusts. 67% used the APLS guideline to manage neonatal SVT, with 3% using a local guideline. However 30% discussed management directly with a paediatric cardiologist. Of those that used the APLS guideline, 36% did this because the baby was haemodynamically compromised. For non-haemodynamically compromised SVT, 84% said they would use vagal manoeuvres as first-line management. If vagal manoeuvres and IV Adenosine failed, 93% of responders would contact a paediatric cardiologist as their next management step. A free-text question on the most difficult decision making dilemmas when faced with neonatal SVT had common comments of what chemical cardioversion could be used if adenosine failed, timing for DC Cardioversion, and when to transfer to regional centre. In terms of acceptability of a regional guideline, 70% said they would be happy to use this. An additional question on out-of-hours availability of ECG machines, showed that 10% of responders had no access to this.
Conclusion The majority of responders indicated that they would happy to use a regional guideline and so we have used the results of this survey to inform this guideline, including guidance for the common dilemmas faced, with clear flowcharts, as well as appendices on the common drugs used. Finally, we would suggest that this guideline could be applicable nationally, via the PECSIG group.
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