Bradycardia in Preterm Infants: Indications and Hazards of Atropine Therapy

Eight preterm infants are presented to demonstrate the indications and hazards of using atropine for treatment of bradycardia in the high-risk premature nursery. Three infants developed bradycardia following initiation of nipple feedings, one following gavage feedings, three following surgical manipulation of visceral structures, and one associated with presence of chronic pulmonary disease. It is suggested that the first seven cases represent "reflexic bradycardia," probably vagally mediated and thus amenable to atropine therapy, whereas the eighth is an example of "hypoxic bradycardia" where administration of atropine may be detrimental. Polygraphic monitoring, arterial blood gases, and the clinical status are helpful in distinguishing reflexic from hypoxic bradycardia. These parameters should be evaluated prior to institution of atropine therapy.