Diagnosis and Management of Hypotension in Neonates

Farrugia, Ryan; Rojas, Héctor; Rabe, Heike

doi:10.2217/fca.13.59

Cited by 7 publications

(5 citation statements)

References 75 publications

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“…Current definitions of cardiovascular insufficiency and shock in neonates are based mainly on BP assessment, despite no clear evidence for the "normal BP" for different gestational age groups [105]. The poor correlation between blood pressure and organ blood flow, together with the lack of evidence that treating hypotension improves neurological outcome, impedes the establishment of clear indications for treatment.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Drug Therapy for Human Newborn: Review of Pharmacodynamic Data

Ergenekon

Rojas-Anaya

Bravo

et al. 2018

CPD

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Background: Circulatory failure in preterm and term newborn infants is commonly treated with inotropes or vasoactive medications. In this structured literature review the available data on pharmacodynamic effects of the inotropes adrenaline, dobutamine, dopamine, levosimendan, milrinone, noradrenaline, and the vasoactive drugs vasopressin and hydrocortisone are presented. Methods: Structured searches were conducted to identify relevant articles according to pre-defined inclusion criteria which were human clinical trials published after 2000.Results: Out of 101 identified eligible studies only 22 studies met the criteria for evidence based practice guidelines level I to IV. The most prevalent pharmacodynamic effects were increase in blood pressure and/or heart rate, which were also the most frequently studied circulatory parameters. Conclusion: This review demonstrates the need for further systematic studies on all reviewed drugs with incorporation of novel noninvasive biomarkers in this vulnerable patient group, for more timely and appropriate treatment for clinical efficacy.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular Drug Therapy for Human Newborn: Review of Pharmacodynamic Data

Ergenekon

Rojas-Anaya

Bravo

et al. 2018

CPD

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“…A diagnosis of hypotension was made clinically if the mean arterial blood pressure was less than the gestational age. 22 All the newborns were treated with hypothermia, since they all met the following clinical criteria: (1) gestational age ≥ 36 weeks and birth weight ≥ 1,800 g; (2) evidence of fetal distress, for example, a history of acute perinatal event, cord pH ≤ 7.0 or base deficit ≤ −16 mEq/L; (3) evidence of neonatal distress, such as an Apgar score ≤ 5 at 10 minutes, postnatal blood gas pH obtained within the first hour of life ≤ 7.0 or base deficit ≤ −16 mEq/L, or a continued need for ventilation initiated at birth and continued for at least 10 minutes; and (4) evidence of moderate or severe encephalopathy determined by a physical examination and/or amplitude-integrated electroencephalogram. The four term asphyxiated newborns were admitted to the neonatal intensive care unit (NICU) within the first 6 hours of life and received whole-body cooling to an esophageal temperature of 33.5°C for 72 hours.…”

Section: Methodsmentioning

confidence: 99%

Secondary Increase of Lactate Levels in Asphyxiated Newborns during Hypothermia Treatment: Reflect of Suboptimal Hemodynamics (A Case Series and Review of the Literature)

Balushi

Guilbault

Wintermark

2015

AJP Rep

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Objective To evaluate whether a secondary increase of serum lactate levels in asphyxiated newborns during hypothermia treatment may reflect suboptimal dynamics. Methods–Retrospective case series and review of the literature. We present the clinical course of four asphyxiated newborns treated with hypothermia who presented with hypotension requiring inotropic support, and who displayed a secondary increase of serum lactate levels during hypothermia treatment. Serial serum lactate levels are correlated with blood pressure and inotropic support within the first 96 hours of life. Results Lactate levels initially decreased in the four patients. However, each of them started to present lower blood pressure, and lactate levels started to increase again. Inotropic support was started to raise blood pressure. The introduction of an epinephrine drip consistently worsened the increase of lactate levels in these newborns, whereas dopamine and dobutamine enabled the clearance of lactate in addition to raising the blood pressure. Rewarming was associated with hemodynamics perturbations (a decrease of blood pressure and/or an increase of lactate levels) in the three newborns who survived. Conclusions Lactate levels during the first 4 days of life should be followed as a potential marker for suboptimal hemodynamic status in term asphyxiated newborns treated with hypothermia, for whom the maintenance of homeostasis during hypothermia treatment is of utmost importance to alleviate brain injury.

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“…There is no doubt that studies to define which infants would benefit from treatment or not are of utmost relevance (5). Hypotension, whatever the definition used, is the most frequent clinical parameter used to initiate treatment (3, 4, 11, 22); as also shown in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…Circulatory impairment is a common complication of the transitional circulation in the preterm infant (1). However, there is no validated scoring system to guide the management of this condition, leading to huge differences in approaches to cardiovascular treatment (CVT) among clinicians (2–5). This is a matter of the utmost importance, as several studies suggest the use of such therapies may increase the risk of adverse outcome in the most vulnerable population (6–8).…”

Section: Introductionmentioning

confidence: 99%

Validity of Biomarkers of Early Circulatory Impairment to Predict Outcome: A Retrospective Analysis

et al. 2019

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Objectives: The definition of circulatory impairment in the premature infant is controversial. Current research suggests overdiagnosis and overtreatment. We aimed to analyse which biomarkers move clinicians to initiate cardiovascular treatment (CVT). The prognostic capacity for adverse outcome (death and/or moderate-severe brain damage by cranial ultrasound at term equivalent) of these biomarkers was evaluated. Study Design: Retrospective data analysis from preterm infants enrolled in a placebo-controlled trial on dobutamine for low superior vena cava (SVC) flow, who showed normal SVC flow within the first 24 h (not randomized). Five positive biomarkers were considered: MABP < gestational age (GA)-1 mmHg; MABP < GA-5 mmHg; lactate > 4 mmol/L; BE < −9 mmol/L; SVC flow <51 ml/kg/min. Results: Ninety eight infants formed the study cohort. Thirty six received CVT (2–95 h). Logistic regression models adjusted for gestational age showed a positive association between CVT and the risk of death or moderate-severe abnormal cranial ultrasound at term equivalent [(OR 5.2, 95%CI: 1.8–15.1) p = 0.002]. MABP < GA-1 mmHg and lactate > 4 mmol/L were the most prevalent biomarkers at start of treatment. Low BE, high serum lactate and low SVC flow at first echocardiography showed a trend toward being associated with adverse outcome, although not statistically significant. Conclusions: Low blood pressure and high lactate are the most prevalent biomarkers used for CVT prescription. Lactic acidosis and low SVC flow early after birth showed a trend toward being associated with adverse outcome. These findings support using a combination of biomarkers for inclusion in a placebo-controlled trial on CVT during transitional circulation.

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Diagnosis and Management of Hypotension in Neonates

Cited by 7 publications

References 75 publications

Cardiovascular Drug Therapy for Human Newborn: Review of Pharmacodynamic Data

Cardiovascular Drug Therapy for Human Newborn: Review of Pharmacodynamic Data

Secondary Increase of Lactate Levels in Asphyxiated Newborns during Hypothermia Treatment: Reflect of Suboptimal Hemodynamics (A Case Series and Review of the Literature)

Validity of Biomarkers of Early Circulatory Impairment to Predict Outcome: A Retrospective Analysis

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