Effects of Dopamine and Dobutamine on Regional Blood Flow Distribution in the Neonatal Piglet

Ferrara, John J.; Dyess, Donna L.; Peeples, Guy L.; Christenberry, D P; Roberts, W.Scott; Tacchi, Ernest J.; Swafford, Albert N.; Ardell, Jeffrey L.; Powell, Randall W.

doi:10.1097/00000658-199505000-00011

Cited by 33 publications

(41 citation statements)

References 14 publications

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“…The effects of dobutamine on hepatosplanchnic hemodynamics are controversial and dependent on the concomitant changes in cardiac output. In most studies, splanchnic blood flow has increased because of dobutamine therapy (13, 31Y35), whereas some studies have reported unchanged (36) or decreased (19,37,38) splanchnic blood flow during dobutamine treatment without detailed assessment of pressure-flow relationships. Because we did not assess the pressure-flow relationship in detail either, the effects of dobutamine on the vascular tone must be interpreted with caution.…”

Section: Discussionmentioning

confidence: 99%

Effects of Low Abdominal Blood Flow and Dobutamine on Blood Flow Distribution and on the Hepatic Arterial Buffer Response in Anaesthetized Pigs

Brander

Jakob

Knuesel

et al. 2006

Shock

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Low cardiac output impairs the hepatic arterial buffer response (HABR). Whether this is due to low abdominal blood flow per se is not known. Dobutamine is commonly used to increase cardiac output, and it may further modify hepatosplanchnic and renal vasoregulation. We assessed the effects of isolated abdominal aortic blood flow changes and dobutamine on hepatosplanchnic and renal blood flow. Twenty-five anesthetized pigs with an abdominal aorto-aortic shunt were randomized to 2 control groups [zero (n = 6) and minimal (n = 6) shunt flow], and 2 groups with 50% reduction of abdominal blood flow and either subsequent increased abdominal blood flow by shunt reduction (n = 6) or dobutamine infusion at 5 and 10 microg kg(-1) min(-1) with constant shunt flow (n = 7). Regional (ultrasound) and local (laser Doppler) intra-abdominal blood flows were measured. The HABR was assessed during acute portal vein occlusion. Sustained low abdominal blood flow, by means of shunt activation, decreased liver, gut, and kidney blood flow similarly and reduced local microcirculatory blood flow in the jejunum. Shunt flow reduction partially restored regional blood flows but not jejunal microcirculatory blood flow. Low-but not high-dose dobutamine increased gut and celiac trunk flow whereas hepatic artery and renal blood flows remained unchanged. Neither intervention altered local blood flows. The HABR was not abolished during sustained low abdominal blood flow despite substantially reduced hepatic arterial blood flow and was not modified by dobutamine. Low-but not high-dose dobutamine redistributes blood flow toward the gut and celiac trunk. The jejunal microcirculatory flow, once impaired, is difficult to restore.

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Section: Discussionmentioning

confidence: 99%

Effects of Low Abdominal Blood Flow and Dobutamine on Blood Flow Distribution and on the Hepatic Arterial Buffer Response in Anaesthetized Pigs

Brander

Jakob

Knuesel

et al. 2006

Shock

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“…Both in preterm newborns and animal models low doses of dopamine induce superior mesenteric artery vasodilation and reduce pulsatility index without affecting systemic BP, similarly to what observed in term neonates and adults [28,60,64]. However, further observations suggest that dopamine enhances blood flow in the renal district but not in the mesenteric one in VLBW infants [54], probably because of functionally immature dopaminergic response of the mesenteric vasculature [54].…”

Section: Indications To Dopamine Treatment In Vlbw Infantsmentioning

confidence: 61%

“…Ultrasound measurements demonstrated increased blood flow in the superior mesenteric artery following dopamine administration both in term and preterm neonates [60,64]. Although certain observations do not agree with the occurrence of mesenteric vasodilation in the preterm population [28,65], the improvement of splanchnic perfusion in VLBW infants would be of considerable clinical importance, considering the close relation between poor local perfusion and risk of necrotizing enterocolitis.…”

Section: Other Systemsmentioning

confidence: 98%

Dopamine Administration in Very Low Birth Weight Preterm Infants:Emerging Issues on Endocrine Effects

Filippi¹,

Poggi²,

Pezzati

2007

CPR

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Preterm newborns weighing less than 1500 g (very low birth weight infants, VLBW) represent a critical population with high prevalence of morbidities, often requiring hemodynamic stabilization. Dopamine is a natural cathecolamine widely used for this purpose because it exerts pleiotropic anti-shock effects on cardiovascular, renal and endocrine systems, acting on adrenergic and dopaminergic receptors. Dopamine is a first choice drug in VLBW infants for inotropic support and optimisation of renal and splanchnic perfusion, mostly indicated for the treatment of hypotension, symptomatic patent ductus arteriosus and renal failure.Dopamine reversibly suppresses pituitary functions in adults but its effects on endocrine balance have been poorly studied in VLBW infants. Recent studies showed a dose-dependant reduction of TSH and T4 plasmatic levels in dopamine-treated VLBW infants and a positive correlation between dopamine infusion and incidence of transient hypothyroxinemia of prematurity.Further studies demonstrated that dopamine infusion also reduces PRL secretion in VLBW infants. TSH, T4 and PRL suppression rapidly reverses after dopamine withdrawal, when a significant hormonal rebound is observed. Therefore, such iatrogenic suppression probably cannot involve long-term injuries and T4 substitutive administration appears unecessary during short course dopamine treatment.Recent observations suggest that dopamine infusion can prevent early diagnosis of congenital hypothyroidism (CH) when screening programs are merely based on TSH plasmatic levels. Considering the severe neurodevelopmental outcome of undiagnosed CH, other screening strategies should be considered in treated neonates, such as simultaneous T4 and TSH testing and hormonal re-evaluation after dopamine discontinuation.A final issue of this review regards a possibile role of dobutamine as an alternative safer inotropic drug. PART 1. DOPAMINE AND DOBUTAMINE ADMINI-STRATION IN PRETERM INFANTS Clinical BackgroundPreterm infants weighing at birth less than 1500 g are referred to as very low birth weight (VLBW) infants and presently account for about 1-3 % of all neonates [1, 2]. However, they represent a widening subset of neonates with major vulnerability among the whole neonatal population. In fact, VLBW infants show a high incidence of morbitidies and systemic hypotension affects approximately one third of these infants [3]. Therefore, they often require early and careful hemodinamic stabilisation and, as a matter of fact, from 4% to 39% of VLBW infants receive inotropic support [3].Even if at present there are no clear evidences that the treatment of systemic hypotension is beneficial [4,5], such condition is widely and aggressively treated in VLBW infants in order to preserve a proper organ perfusion and an adequate cerebral blood flow [3,4,[6][7][8][9][10][11][12] since hypotension results associated with increased risk of intraventricular haemorrhage and unfavourable neurodevelopmental outcome [13][14][15][16]. Impaired cerebral autoregulation has been dem...

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“…Similarly, some of the studies showed an increase in heart rate in a dose-dependent manner [5], [9], [11]–[13], [16], [18], [23], [26], [28]. An increase in stroke volume was mainly observed in studies using prolonged infusion (from 2 to 6 h) at doses higher than 10 µg/kg/min [6], [8], [9], [17].…”

Section: Resultsmentioning

confidence: 84%

“…Some found no changes in arterial blood pressure [7]–[9], [17], [20], [24], [28], but in a few studies the arterial blood pressure increased at the highest dose studied [6], [11], [19], [26], [27]. Similarly, some of the studies showed an increase in heart rate in a dose-dependent manner [5], [9], [11]–[13], [16], [18], [23], [26], [28].…”

Section: Resultsmentioning

confidence: 97%

Dobutamine in Paediatric Population: A Systematic Review in Juvenile Animal Models

2014

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ObjectiveAlthough dobutamine is widely used in neonatal clinical practice, the evidence for its use in this specific population is not clear. We conducted a systematic review of the use of dobutamine in juvenile animals to determine whether the evidence from juvenile animal experiments with dobutamine supported the design of clinical trials in neonatal/paediatric population.MethodsStudies were identified by searching MEDLINE (1946–2012) and EMBASE (1974–2012). Articles retrieved were independently reviewed by three authors and only those concerning efficacy and safety of the drug in juvenile animals were included. Only original articles published in English and Spanish were included.ResultsFollowing our literature search, 265 articles were retrieved and 24 studies were included in the review: 17 focused on neonatal models and 7 on young animal models. Although the aims and design of these studies, as well as the doses and ages analysed, were quite heterogeneous, the majority of authors agree that dobutamine infusion improves cardiac output in a dose dependent manner. Moreover, the cardiovascular effects of dobutamine are influenced by postnatal age, as well as by the dose used and the duration of the therapy. There is inadequate information about the effects of dobutamine on cerebral perfusion to draw conclusions.ConclusionThere is enough preclinical evidence to ensure that dobutamine improves cardiac output, however to better understand its effects in peripheral organs, such as the brain, more specific and well designed studies are required to provide additional data to support the design of clinical trials in a paediatric population.

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Effects of Dopamine and Dobutamine on Regional Blood Flow Distribution in the Neonatal Piglet

Abstract: Dopamine may prove a valuable adjunct when a premature infant is at risk for conditions that reduce alimentary tract blood flow.

Cited by 33 publications

References 14 publications

Effects of Low Abdominal Blood Flow and Dobutamine on Blood Flow Distribution and on the Hepatic Arterial Buffer Response in Anaesthetized Pigs

Effects of Low Abdominal Blood Flow and Dobutamine on Blood Flow Distribution and on the Hepatic Arterial Buffer Response in Anaesthetized Pigs

Dopamine Administration in Very Low Birth Weight Preterm Infants:Emerging Issues on Endocrine Effects

Dobutamine in Paediatric Population: A Systematic Review in Juvenile Animal Models

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