Hypercontractile heart failure caused by catecholamine therapy in premature neonates

Abstract

Catecholamine treatment for hypotension is common practice in neonatal intensive care units. In the presence of left ventricular hypertrophy, the positive inotropic action of catecholamines with mainly β‐receptor specificity can lead to excessive hypercontractility and paradoxical hypotension. This reports presents two cases of hypercontractile heart failure during β‐agonist treatment in very low birthweight (VLBW) infants. Both patients (27 wk, 5 d; and 26 wk, 6 d of gestation) underwent surgical arterial duct ligation and coarctation repair. After operation they developed arterial hypotension that failed to respond to epinephrine (adrenaline) or dobutamine treatment. Echocardiography demonstrated a complete systolic obliteration of the left ventricular cavity. Epinephrine and dobutamine were stopped, and norepinephrine (noradrenaline) was successfully used to control the hypotension. Conclusion: Treatment of hypotension with β‐agonists in VLBW infants with left ventricular hypertrophy can lead to hypercontractility and left ventricular obliteration with paradoxical hypotension. Careful echocardiographic monitoring is indicated in such cases.

The Use of Cardiotonic Drugs in Neonates

“…The infusion should be administered through a central venous line with a dosing range of 0.05-1.0 mcg/kg/min. Higher doses of have been used but are not recommended 57,58 .…”

Epinephrine Overdose–Associated Hypokalemia and Rhabdomyolysis in a Newborn

“…However, complications in newborns or children are rarely described. [1][2][3][4][5][6][7][8][9] Differences in catecholamine metabolism between neonates and adults may contribute to their different clinical presentations of epinephrine overdose. 10 We describe the case of a 4-day-old newborn who was inadvertently given epinephrine at 100 times the usual dose.…”

Caution with prolonged or high‐dose infusions of catecholamines in premature infants

“…dopamine or dobutamine), to correct systemic hypotension in neonates. Germanakis et al describe two cases of paradoxical hypotension, in premature infants who had both a coarctation of the aorta and a patent ductus arteriosus, in the immediate postoperative period 1. In both cases the hypotension, which was refractory to cardiotropic agents with β‐adrenergic effects, responded to an α‐adrenergic agonist (norepinephrine).…”