Nicardipine to Control Neonatal Hypertension During Extracorporeal Membrane Oxygen Support

Abstract

We recommend a conservative initial dose of nicardipine of 0.5 micro g/kg/min that is aggressively titrated to reduce blood pressure effectively in neonates receiving ECMO therapy.

Pharmacotherapy during pediatric extracorporeal membrane oxygenation: a review

“…Minimal efficacy and PK data exist for vasodilator use on ECMO. Case reports exist for nicardipine that suggest recommended dosing ranges to be used while on ECMO [89,90]. A case report has also been published with the use of nesiritide that suggests higher maintenance dosing may be necessary [91].…”

Drug Treatment of Hypertensive Crisis in Children

“…[28][29][30][31][32][33][34][35] Possessing a higher propensity to induce vascular smooth muscle relaxation and peripheral vasodilation (primarily arterial) relative to its cardiac specificity, it is considered one of the first-line agents for the management of hypertensive crises. [3] Since it does maintain some cardiac activity, nicardipine successfully decreases SVR without causing profound reflex tachycardia.…”

“…Dosages start at 0.2-0.5 mg kg min, can be titrated upward every 15 minutes, and typically reach their peak around 3 mg kg min, although higher dosages have been reported (table I). [28][29][30][31][32][33][34][35] Nicardipine is metabolized via cytochrome P450 (CYP) enzymes and is partially eliminated as free drug and metabolites in urine and feces. Clearance may be decreased in the presence of hepatic dysfunction, but adjustment for renal dysfunction is not necessary.…”

“…[28][29][30][31][32][33][34][35] Although data are relatively more plentiful on the use of nicardipine compared with other agents, like all medications used for hypertensive crisis in pediatrics, large randomized controlled clinical trials are non-existent. In 1993, Treluyer and colleagues [28] reported a case series of 14 severely hypertensive patients, who ranged from 9 days to nearly 11 years of age.…”

“…Significant hypotension or tachycardia was not observed in either study. [30,31] Several other papers [32][33][34][35] have increased the available data on the use of nicardipine by reporting the results of its use in pediatric cases. Reported dosages ranged from 0.5 to 5 mg kg min in preterm neonates to patients aged 14 years.…”