iarmsIARMSIARMS2709-3255https://doi.org/10.47310/iarms.2020.v01i01.011Combined use of Propranolol and Diltiazem in termination of Adenosine non responsive Paroxysomal supraventricular tachycardia in a neonate in a resource limited settingSaugatGhoshSrivastavaParoxysmal Supraventricular Tachycardia (PSVT) is the second most common arrhythmia in children and frequently presents during infancy, with a significant proportion occurring in the neonatal period. Prompt recognition and management are essential to prevent hemodynamic compromise. Adenosine is the first-line therapy for acute termination; however, treatment options become limited in adenosine-refractory cases, particularly in resource-limited settings where neonatal defibrillators for DC cardioversion may not be available. We report the case of a 20-day-old, 3-kg female neonate who presented with excessive crying and poor feeding for one day. Clinical examination revealed a heart rate of 290 beats per minute with preserved perfusion and stable vital signs. Electrocardiography showed narrow-complex tachycardia with absent P waves, consistent with PSVT. Vagal maneuvers and two doses of intravenous adenosine (0.1 mg/kg) failed to terminate the arrhythmia. Subsequent administration of intravenous amiodarone was also ineffective. In the absence of a neonatal defibrillator, intravenous diltiazem was initiated, followed by infusion, but tachycardia persisted. Oral propranolol (1 mg/kg stat) was then administered concurrently, resulting in successful termination of PSVT within 30–45 minutes. Post-conversion ECG was normal and the neonate remained stable, tolerated oral feeds and was transferred to the ward with her mother.