Use of Aminocaproic Acid With Bivalirudin for Hemostatic Management of Abdominal Surgery for Neonate on Extracorporeal Support

A preterm neonate (34 weeks of gestation) weighing 2.5 kg with a history of fetal supraventricular tachycardia (SVT, successfully treated with maternal flecainide, though fetal development of ascites was noted) was transferred to our institution at 10 days of life. Pretransfer electrocardiogram revealed preexcitation, with intermittent orthodromic narrow complex tachycardia at a rate of 220 bpm (Figure 1). Before transfer, antiarrhythmic treatment strategies included propranolol, flecainide, amiodarone, and electrical cardioversion. On the day of transfer, the patient developed incessant SVT, with onset of emesis, hematochezia, abdominal distension, and pneumatosis on abdominal x-ray concerning for necrotizing enterocolitis (NEC).