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

Seri, István; Rudas, Gábor; Bors, Z; Kanyicska, B.; Tulassay, Tivadar

doi:10.1203/00006450-199312000-00009

Cited by 141 publications

(94 citation statements)

References 29 publications

(50 reference statements)

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“…4,8,9,13,18 -39 For studies using a case-control design or random assignment to therapy for hypotension, sample sizes and associated effect size estimates of the efficacy of dopamine therapy for increasing blood pressure in comparison with epinephrine, dobutamine, hydrocortisone, colloid or no therapy are presented in Table 2. 4,9,13,17,18,21,22,[24][25][26]28,29,31 Sample sizes and associated effect size estimates for studies examining CBF are presented in Table 3. 8,9,18,25,29,36,37,40 Sample sizes and associated effect size estimates for studies examining adverse neurologic outcome are presented in Table 4.…”

Section: Resultsmentioning

confidence: 99%

“…4,9,13,17,18,21,22,[24][25][26]28,29,31 Sample sizes and associated effect size estimates for studies examining CBF are presented in Table 3. 8,9,18,25,29,36,37,40 Sample sizes and associated effect size estimates for studies examining adverse neurologic outcome are presented in Table 4. 13,19,20,24,26,28,30,32 Results are reported for the random effects meta-analytic approach, in which individual studies are considered the sampling unit, allowing generalization to other studies of the population from which this set of studies can be considered a sample, and the fixed effects meta-analytic approach, in which participants in the individual studies are considered the sampling unit.…”

Section: Resultsmentioning

confidence: 99%

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A meta-analysis of dopamine use in hypotensive preterm infants: blood pressure and cerebral hemodynamics

2011

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Objective: Dopamine administration results in variable effects on blood pressure in hypotensive preterm infants. The clinical benefits of dopamine administration in increasing cerebral blood flow (CBF) and reducing adverse neurological outcomes in hypotensive preterm neonates are unclear. The objective of this study was to examine the efficacy of dopamine for treatment of hypotension and investigate the changes in cerebral hemodynamics and central nervous system injury in hypotensive preterm infants following dopamine administration.Study Design: Standard meta-analytic techniques, including random and fixed effects models, were used to calculate combined effect size correlations and significance levels.Result: Random effects meta-analysis found that dopamine increases mean arterial blood pressure (12 studies; N ¼ 163; r ¼ 0.88, 95% confidence interval (CI) ¼ 0.76 to 0.94) and systolic blood pressure (8 studies; N ¼ 142; r ¼ 0.81, 95% CI ¼ 0.42 to 0.94). For the increase in blood pressure, dopamine administration was associated with a significantly greater overall efficacy than dobutamine (seven studies; N ¼ 251; r ¼ 0.26; 95% CI ¼ 0.20 to 0.32), colloid (two studies; N ¼ 67; r ¼ 0.60; 95% CI ¼ 0.41 to 0.74) and hydrocortisone (one study; N ¼ 28; r ¼ 0.40; 95% CI ¼ 0.034 to 0.67). CBF increased following dopamine administration (five studies; N ¼ 75; r ¼ 0.36; 95% CI ¼ À0.059 to 0.67) and the increase in CBF was greater in hypotensive than normotensive preterm infants (eight studies; N ¼ 153; r ¼ 0.16; 95% CI ¼ À0.0080 to 0.32). There were no statistically significant differences in adverse neurological outcome between dopamine and dobutamine (three studies; N ¼ 118; r ¼ À0.13; 95% CI ¼ À0.31 to 0.059), epinephrine (two studies; N ¼ 46; r ¼ 0.06; 95% CI ¼ À0.23 to 0.34), colloid (two studies; N ¼ 80; r ¼ 0.0070; 95% CI ¼ À0.218 to 0.23) or hydrocortisone administration (one study; N ¼ 40; r ¼ À0.10; 95% CI ¼ À0.40 to 0.22).Conclusion: Dopamine administration increases mean and systolic blood pressure in hypotensive preterm infants, and is more effective than dobutamine, colloid or hydrocortisone alone. Dopamine administration is associated with increased CBF, with greater increases in CBF in hypotensive than in normotensive preterm infants. Dopamine is not associated with a greater incidence of adverse effects than other therapies used to treat hypotension.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

A meta-analysis of dopamine use in hypotensive preterm infants: blood pressure and cerebral hemodynamics

2011

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“…Indeed, findings of an earlier study support this notion and indicate that, in sick preterm neonates, it may take up to 30-40 min or more for CBF autoregulation to recover after blood pressure has been normalized. 28 In summary, treatment of the hypotensive 1-day-old VLBW neonate remains complex even if systemic perfusion can be assessed by functional echocardiography. The use and stepwise titration of low-to-moderate dose dopamine 3,6,20,22,28 or epinephrine 22 to achieve blood pressure values 3 to 6 points higher than the gestational age of the patient is the preferred approach by many neonatologists during the first postnatal day.…”

Section: Introductionmentioning

confidence: 99%

“…28 In summary, treatment of the hypotensive 1-day-old VLBW neonate remains complex even if systemic perfusion can be assessed by functional echocardiography. The use and stepwise titration of low-to-moderate dose dopamine 3,6,20,22,28 or epinephrine 22 to achieve blood pressure values 3 to 6 points higher than the gestational age of the patient is the preferred approach by many neonatologists during the first postnatal day. However, if there is evidence of myocardial dysfunction, dobutamine should be the first-line medication and low-dose dopamine may be added if blood pressure decreases upon initiation of dobutamine administration.…”

Section: Introductionmentioning

confidence: 99%

Management of hypotension and low systemic blood flow in the very low birth weight neonate during the first postnatal week

Seri

2006

J Perinatol

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Systemic hypotension during the first postnatal week is associated with increased mortality and morbidity in the very low birth weight (VLBW) neonate. Hypotension is generally defined as blood pressure below the fifth percentile of the gestational-and postnatal-age dependent blood pressure norms. Recent studies indicate that in most VLBW neonates, cerebral blood flow autoregulation is indeed lost when blood pressure reaches the fifth percentile. Treatment of the circulatory compromise should address the primary pathogenic factor(s) of the condition (hypovolemia, myocardial compromise, failure of vasoregulation or a combination of factors). Recent findings also suggest that vasopressor resistance can be treated with a brief course of low-dose hydrocortisone. However, due to the short-and potential long-term side effects of early hydrocortisone treatment, its use should be restricted to neonates with vasopressor-resistant hypotension. Finally, concomitant administration of hydrocortisone with indomethacin should be avoided due to the increased incidence of gastrointestinal perforations.

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“…1 In preterm infants, the complex physiology of the postnatal transition and the inherent immaturity of the cardiopulmonary and other organ systems present the most important challenge of establishing normative values, as continuous blood pressure monitoring in itself is insufficient to identify abnormal organ blood flow and tissue oxygen delivery in this patient population. 2 Furthermore, although there is an abundance of evidence showing improvement in blood pressure and other cardiovascular parameters, such as cardiac output, cerebral and non-vital organ blood flow and renal function, when 'hypotension' is treated during postnatal transition, [3][4][5][6][7][8][9][10] there are no data showing that treatment results in improvements in long-term outcome.…”

Section: Introductionmentioning

confidence: 99%

Definition of hypotension and assessment of hemodynamics in the preterm neonate

2009

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The complexity of postnatal cardiovascular transition has only recently been better appreciated in the very low birth weight neonate. As blood pressure in itself poorly represents systemic blood flow, especially when the fetal channels are open and the developmentally regulated vital organ assignment may not have been completed, efforts to measure systemic blood flow have resulted in a novel, yet incomplete, understanding of the principles and clinical relevance of cardiovascular adaptation during postnatal transition in this patient population. This article describes the definition of hypotension based on the principles of cardiovascular physiology, and reviews the tools available to the clinician and researcher at the bedside to examine the complex relationship among blood pressure, systemic and organ blood flow, and tissue oxygen delivery and oxygen demand in vital and non-vital organs in the very low birth weight neonate. Only after gaining an insight into these complex relationships and processes will we be able to design clinical trials of selected treatment modalities targeting relevant patient sub-populations for the management of neonatal cardiovascular compromise. Only clinical trials based on a solid understanding of developmental cardiovascular physiology tailored to the appropriate patient sub-population hold the promise of being effective and practical, and can lead to improvements in both hemodynamic parameters and clinically relevant outcome measures.

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

Cited by 141 publications

References 29 publications

A meta-analysis of dopamine use in hypotensive preterm infants: blood pressure and cerebral hemodynamics

A meta-analysis of dopamine use in hypotensive preterm infants: blood pressure and cerebral hemodynamics

Management of hypotension and low systemic blood flow in the very low birth weight neonate during the first postnatal week

Definition of hypotension and assessment of hemodynamics in the preterm neonate

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