ABSTRACT:The developmentally regulated hemodynamic effects of vasoactive medications have not been well characterized. We used traditional and near-infrared spectroscopy monitoring technologies and investigated the changes in heart rate, blood pressure, common carotid artery (CCA) blood flow (BF), cerebral, renal, intestinal, and muscle regional tissue O 2 saturation, and acid-base and electrolyte status in response to escalating doses of vasoactive medications in normotensive anesthetized neonatal piglets. We used regional tissue O 2 saturation and CCA BF as surrogates of organ and systemic BF, respectively, and controlled minute ventilation and oxygenation. Low to medium doses of dopamine, epinephrine, dobutamine, and norepinephrine increased blood pressure and systemic and regional BF in a drug-specific manner, whereas milrinone exerted minimal effects. At higher doses, dopamine, epinephrine, and norepinephrine but not dobutamine decreased systemic, renal, intestinal, and muscle BF, while cerebral BF remained unchanged. Epinephrine induced significant increases in muscle BF and serum glucose and lactate concentrations. The findings reveal novel drug-and dose-specific differences in the hemodynamic response to escalating doses of vasoactive medications in the neonatal cardiovascular system and provide information for future clinical studies investigating the use of vasoactive medications for the treatment of neonatal cardiovascular compromise. (Pediatr Res 70: 473-479, 2011) C ardiovascular compromise is a frequently encountered condition in the critically ill preterm and term infant (1) resulting in inadequate tissue O 2 delivery, impaired cerebral blood flow (CBF) autoregulation, and, potentially, end-organ injury and death (1-3). Our limited ability to accurately monitor changes in neonatal hemodynamics curtails timely recognition, and thus treatment, of neonatal shock.Although vasopressor-inotropes, inotropes, and lusitropes have been used to manage neonatal cardiovascular compromise with an attempt to tailor the treatment to the suspected primary etiology (1), there is only limited information available on the safety and effectiveness of these medications (1,4) and little is known about their developmentally regulated dose-dependent hemodynamic actions (4,5). Recent advances in bedside hemodynamic monitoring techniques using, among others, near-infrared spectroscopy (NIRS) have made continuous, noninvasive monitoring of tissue O 2 delivery (6) possible. Accordingly, data on tissue O 2 delivery and utilization (7) and regional O 2 saturation in critically ill adults, children, and, more recently, neonates have become available (2,3,8 -10).To gain insight into the specific, drug-related changes in neonatal hemodynamics, we used traditional and NIRS hemodynamic monitoring technologies and investigated the changes in heart rate, blood pressure (BP), common carotid artery (CCA) blood flow (BF), cerebral regional tissue O 2 saturation (CrSO 2 ), renal (kidney) regional tissue O 2 saturation (KrSO 2 ), intestina...
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