A Novel Rectal Propranolol Strategy in Neonatal Supraventricular Tachycardia Complicated by Surgical Necrotizing Enterocolitis
Year: 2026
Type: article
Study design: Case Report
Abstract: Objective Surgical necrotizing enterocolitis (NEC, Bell stage 3B) complicating neonatal supraventricular tachycardia (SVT) is exceedingly rare. We describe a novel per-rectal propranolol strategy to maintain antiarrhythmic prophylaxis during mandatory nil per oral (NPO) status imposed by NEC. Study Design This study includes a single case report at a tertiary neonatal unit in Western India. Results A 35-week neonate with antenatal fetal tachyarrhythmia (>300 beats per minute [bpm]) developed postnatal SVT at 6 h of life (280–300 bpm), requiring adenosine cardioversion and oral propranolol. On day of life (DOL) 4, hematochezia, abdominal distension, and portal venous gas indicated Bell stage 3A NEC, mandating NPO status. With enteral routes contraindicated, propranolol was continued per rectum, to our knowledge the first reported neonatal antiarrhythmic use of this route. Deterioration to pneumoperitoneum by DOL 8 necessitated laparotomy with jejuno–jejunal and ileo–caecal resection and anastomosis. No SVT recurred during NPO. The infant was discharged on DOL 25 on oral propranolol. Conclusion This first Indian report of SVT-associated surgical NEC highlights two novelties: Bell stage 3B NEC requiring surgery and per-rectal propranolol as a novel antiarrhythmic bridge during NPO. Clinicians should maintain vigilance for NEC in neonates with SVT regardless of hemodynamic stability, and consider the rectal route for propranolol when NPO.
DOI: 10.1055/a-2942-1294
Authors: M. Siddharth, Ashishkumar Banpurkar, Abhijit Benare, Anusha Rao, Umesh Vaidya, Komal Bijarniya, Manali Bhuyan, Bhakti Dhamangaonkar
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,300
OpenAlex ID: W7204917600
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