Cardiovascular response to dopamine in hypotensive preterm neonates with severe hyaline membrane disease

Abstract

The effect of low dose (2, 4, and 8 micrograms/kg per min) dopamine infusion on blood pressure, heart rate and renal function was studied in 18 hypotensive, preterm infants with severe hyaline membrane disease (HMD). Significant dose-related effects found during dopamine infusion were systolic and diastolic blood pressure elevation and diuretic effect, while heart rate increase occurred only with 8 micrograms/kg per min of the drug. This indicates, that in the preterm neonate, dopamine at low doses has a pronounced effect on the alpha- and dopamine-receptors, while its beta-receptor stimulating activity is minimal. We demonstrated a significantly decreased metabolic clearance rate of dopamine in preterm infants. Thus, beside the differences in the vascular receptors' maturation, the decreased metabolic clearance rate should also be taken into account when explaining the cardiovascular and renal effects of low dose dopamine infusion in these babies. Dopamine was found to be useful in normalizing low arterial blood pressure, in improving impaired peripheral circulation, and in producing a marked diuresis in hypotensive preterm neonates with severe hyaline membrane disease.

Effects of Low-Dose Dopamine Infusion on Cardiovascular and Renal Functions, Cerebral Blood Flow, and Plasma Catecholamine Levels in Sick Preterm Neonates

“…In children and adults, dopamine, in increasing concentrations, activates the dopaminergic, then the 8-adrenergic, and finally the a-adrenergic recep tors (10). The present findings and our earlier observations (3,8,32,33) as well as those reported by others (2,34) suggest that the order of receptor sensitivity is different in the preterm infant, i.e. clinical signs of stimulation of the a-adrenoreceptors and dopamine receptors occur before those of the 8-adrenoreceptors.…”

“…However, several recent reports indicate that lower doses of the drug may be effective in both term and preterm neonates (3-5). In addition, we have also suggested that the minimally effective cardiovascular dose of dopamine may be even lower in preterm than in term infants (3,8,9). However, this enhanced cardiovascular responsiveness of the preterm infant to dopamine has not been confirmed.…”

Levels of Catecholamines, Arginine Vasopressin and Atrial Natriuretic Peptide in Hypotensive Extremely Low Birth Weight Infants in the First 24 Hours after Birth

“…Dopamine (diluted in 10% dextrose) was infused continuously via a central venous line (25 gauge, PI Double Lumen Catheter Kit TM , Argyle, Japan). The initial infusion rate of dopamine (ranging between 2 and 5 g/kg/min) was deter-mined by an attending physician on the basis of the clinical status of the patient [1][2][3][4][5]15] . When dopamine of 5 g/kg/min failed to normalize the blood pressure, dobutamine was added.…”

“…Dopamine is known to increase cardiac contractility and peripheral vascular tone via dose-dependent stimulation of the ␣ -, ␤ -and dopamine receptors [2,4,5] . In infants with mild hypotension, lower doses (2-10 g/ kg/min) of dopamine may be effective [1][2][3][4][5] because lowdose dopamine stimulates mostly dopamine and ␤ -adrenergic receptors with less effect on peripheral vascular resistance. At higher doses ( 1 10 g/kg/min), ␣ -adrenergic effects increase on both pulmonary and systemic vasculature, which causes elevation of blood pressure [5,7] .…”

Erratum: Response to dopamine in prematurity: a biomarker for brain injury?

“…[4][5][6][7][8][9] Given the paucity and heterogeneity of normative data in this very preterm population, there is considerable variance in management of hypotension 10 ; approximately 55-82% of infants born before 28 weeks EGA receive some form of therapy for hypotension, generally volume resuscitation and/or vasoactive medications, the most common of which is dopamine. 11,12 Dopamine, a non-selective adrenergic agonist, has been widely used for the treatment of hypotension in preterm infants for several decades 7,13,14 and has been compared to a number of other anti-hypotensive regiments, demonstrating that dopamine is superior, or at least equivalent, with a more limited side-effect profile. [15][16][17][18][19][20][21][22][23][24][25] However, there is a relative lack of data about isolated use of dopamine in the hypotensive preterm infant.…”