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CNS Adverse Effects of Cisapride in Children

cainide concentration in the baby at birth was 720 μg/L. Neither the removal of 150 mL ascitic fluid from the abdomen nor the administration of dobutamine at 10 μg/kg/min made any improvement. Enoximone infusion of 10 μg/kg/min resulted in immediate and sustained improvement, and the ECG and echocardiographic appearances subsequently became normal (PR interval 140 msec, QRS 56 msec, QTc 446 msec). Although there is limited information on the use of enoximone in infants, it has been shown to be beneficial in newborns with low cardiac output.2 Discussion. The ECG and echocardiography suggested that the baby’s poor cardiac function was secondary to flecainide toxicity and that poor prenatal cardiac function may have been responsible for the persistent fetal ascites. We are not aware of any other reports of neonatal flecainide cardiotoxicity after exposure in utero, although there have been intra-uterine deaths within 24 hours of initiation of flecainide.3 In a report of flecainide overdose, the effects of increased PR, QRS, and QTc intervals were noted on the ECG. As the flecainide concentrations decreased, the QRS width reduced.4 Use of the Naranjo probability scale indicated a possible relationship between cardiotoxicity and flecainide treatment in this newborn.5 We conclude that the antenatal treatment of SVT with antiarrhythmics that include flecainide may fail to improve cardiac function even when the heart rate is controlled; that enoximone may be a better treatment than dobutamine for pump failure in flecainide toxicity; and that, since flecainide has a short half-life, the situation should improve by itself given appropriate supportive treatment.