Eleni Papaioannou

Fetal supraventricular tachycardia (SVT) is the predominant sustained fetal tachyarrhythmia and, when persistent, can progress to tachycardia-induced myocardial dysfunction and nonimmune hydrops fetalis (NIHF), a condition associated with substantial perinatal morbidity and mortality. Although digoxin has historically served as first-line therapy, flecainide demonstrates superior transplacental bioavailability and higher cardioversion rates in hydropic fetuses, in whom placental edema may impair digoxin transfer. We report a case of fetal SVT complicated by hydrops fetalis at 30 weeks’ gestation that achieved complete intrauterine reversal following maternal flecainide therapy. A 31-year-old woman was referred after fetal echocardiography demonstrated SVT with a ventricular rate of approximately 300 beats per minute and 1:1 atrioventricular conduction, alongside fetal ascites and pericardial effusion consistent with NIHF. Oral flecainide was initiated and subsequently up-titrated because of persistent fetal tachycardia. Sinus rhythm was restored on treatment day 10, followed by complete sonographic resolution of hydrops by 32+6 weeks’ gestation. Labor was induced at 38 weeks, resulting in vaginal delivery of a clinically stable male infant. Postnatally, prophylactic propranolol was started, but recurrent SVT on days 4 and 13 of life required escalation to flecainide and adenosine cardioversion before discharge in sinus rhythm. This case illustrates that regression of hydrops, rather than restoration of sinus rhythm alone, represents a more clinically meaningful marker of fetal cardiovascular recovery and underscores the importance of timely transplacental antiarrhythmic therapy and structured postnatal surveillance, given the well-documented risk of arrhythmia recurrence in infants with a history of fetal SVT complicated by hydrops.

Neonatal echocardiography remains an essential imaging modality for the assessment of congenital and hemodynamic cardiovascular abnormalities in critically ill neonates. Recent advances in quantitative ultrasound biomarkers, deformation imaging, volumetric reconstruction, and artificial intelligence (AI)-assisted analysis have substantially expanded the diagnostic capabilities of neonatal cardiovascular ultrasound imaging. This narrative review critically examines current developments in quantitative echocardiographic imaging, advanced volumetric methodologies, and AI-assisted cardiovascular ultrasound analysis, with emphasis on neonatal intensive care applications. A literature search was conducted using PubMed, Google Scholar, Scopus and Embase focusing on neonatal echocardiography, spatiotemporal image correlation (STIC), speckle-tracking echocardiography, artificial intelligence, machine learning, and quantitative cardiovascular imaging. Recent studies suggest that advanced methodologies, including speckle-tracking echocardiography, STIC-based reconstruction, automated segmentation algorithms, and deep learning frameworks, may improve image standardization, automated quantification, and congenital heart disease detection. However, important challenges persist, including operator dependency, dataset heterogeneity, limited external validation, cross-platform variability, and incomplete integration into routine neonatal intensive care workflows. Most AI-assisted echocardiographic systems remain investigational and require further prospective multicenter validation before widespread clinical implementation can be achieved.

Antimicrobial resistance is a growing threat in neonatal intensive care units (NICUs) worldwide, challenging the management of neonatal sepsis for decades. The aim of this narrative review is to compare the epidemiology and resistance patterns of neonatal sepsis in NICUs between two periods, 2000–2005 and 2020–2025, and to identify key insights that may inform future practices to limit the emergence and dissemination of antimicrobial resistance in NICUs. During the early 2000s, resistant pathogens, including extended-spectrum beta-lactamases (ESBL)-producing Enterobacterales, vancomycin-resistant Enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and coagulase-negative Staphylococci (CoNS), were increasingly reported in NICUs. The increasing prevalence of antimicrobial resistant strains was associated with the widespread use of broad-spectrum antibiotics, exerting selective pressure that contributed to the emergence of multidrug-resistant pathogens in the 2020s, including carbapenem-resistant Enterobacterales (CRE) and multidrug-resistant Acinetobacter baumannii, and to the further dissemination of resistant strains in NICUs. The evolution of antimicrobial resistance over the past twenty years highlights that preserving the effectiveness of antibiotics, through rational antibiotic use, is a key strategy to limit the emergence of resistant pathogens. This is of particular importance for the neonatal population due to the limited therapeutic options. Although antimicrobial stewardship programs have been implemented in numerous NICUs with encouraging results, optimization of antibiotic use requires the identification of biomarkers that can promptly and accurately diagnose sepsis and the development of new effective antimicrobial agents against multidrug-resistant pathogens. Future research is expected to improve diagnostic precision, therapeutic options, and stewardship strategies to limit the spread of antimicrobial resistance.

Antimicrobial resistance is a growing threat in neonatal intensive care units (NICUs) worldwide, challenging the management of neonatal sepsis for decades. The aim of this narrative review is to compare the epidemiology and resistance patterns of neonatal sepsis in NICUs between two periods, 2000-2005 and 2020-2025, and to identify key insights that may inform future practices to limit the emergence and dissemination of antimicrobial resistance in NICUs. During the early 2000s, resistant pathogens, including extended-spectrum beta-lactamases (ESBL)-producing Enterobacterales, vancomycin-resistant Enterococcus (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and coagulase-negative Staphylococcus (CoNS), were increasingly reported in NICUs. The increasing prevalence of antibiotic-resistant strains was associated with the widespread use of broad-spectrum antibiotics, exerting selective pressure that contributed to the emergence of multidrug-resistant pathogens in the 2020s, including carbapenem-resistant Enterobacterales (CRE) and multidrug-resistant Acinetobacter baumanni, and to the further dissemination of resistant strains in NICUs. The evolution of antimicrobial resistance over the past twenty years highlights that preserving the effectiveness of antibiotics, through rational antibiotic use, is a key strategy to limit the emergence of resistant pathogens. This is of particular importance for the neonatal population due to the limited therapeutic options. Although antimicrobial stewardship programs have been implemented in numerous NICUs with encouraging results, optimization of antibiotic use requires the identification of biomarkers that can promptly and accurately diagnose sepsis and the development of new effective antimicrobial agents against multidrug-resistant pathogens. Future studies are expected to further enhance diagnostic precision, therapeutic options, and stewardship strategies to limit the spread of antibiotic resistance.