Pharmacokinetics of dopamine in critically ill newborn infants

Padbury, Jamés F.; Agata, Youtaro; Baylen, Barry G.; Ludlow, John K.; Polk, Daniel H.; Habib, David M.; Martinez, Alma M

doi:10.1016/s0022-3476(05)81101-1

Cited by 53 publications

(45 citation statements)

References 10 publications

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“…These studies therefore concluded that vasoconstriction may be the primary mechanism underlying blood pressure elevation by dopamine in premature infants. This interpretation is not consistent with our findings or with a number of earlier findings reported in the literature (16)(17)(18). The similarity in the magnitude of increase in blood pressure and LBF may indicate that peripheral vascular resistance is unchanged by dopamine administration per the equation "vascular resistance = blood pressure/blood flow. "…”

Section: Discussioncontrasting

confidence: 99%

“…Several authors have used echocardiography to evaluate the myocardial effects of dopamine. Although complicating factors such as the existence of patent ductus arteriosus in preterm infants may make the interpretation of echocardiographical data difficult, most studies have demonstrated positive results of echocardiographical evaluation, such as increased myocardial contractility (16) and increased cardiac output (17,18). In contrast, some studies found that dopamine increased blood pressure without causing an improvement in echocardiographical parameters such as left ventricular output (19) and superior vena cava blood flow (20).…”

Section: Discussionmentioning

confidence: 99%

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Effect of dopamine on peripheral perfusion in very-low-birth-weight infants during the transitional period

et al. 2012

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of dopamine on peripheral perfusion in very-low-birth-weight infants during the transitional period

et al. 2012

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“…This response was most significant in preterm fetuses (94-121 days) and was not present in adult sheep (34). In adults and children, ϳ20% of infused dopamine is converted to NE, and dopamine also triggers release of stored NE from nerve endings (27), although sick preterm infants may not exhibit dose-dependent increases in NE during dopamine infusion (20). We did observe a small increase in NE in our fetuses at increasing dopamine doses.…”

Section: Discussionmentioning

confidence: 52%

“…However, an interesting finding was that, at increasing dopamine infusion rates, the plasma dopamine and NE concentrations were lower in preterm than in near-term fetuses. In addition, the levels in both groups of fetuses were lower than those reported for human infants receiving exogenous dopamine (2,20,27). The most likely explanation for this finding is enhanced placental transfer and clearance of catecholamines in more preterm fetuses.…”

Section: Discussionmentioning

confidence: 59%

Cerebrovascular effects of intravenous dopamine infusions in fetal sheep

Gleason

Robinson

Harris

et al. 2002

Journal of Applied Physiology

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man. Cerebrovascular effects of intravenous dopamine infusions in fetal sheep. J Appl Physiol 92: 717-724, 2002; 10.1152/japplphysiol.00600.2001.-Preterm infants are often treated with intravenous dopamine to increase mean arterial blood pressure (MAP). However, there are few data regarding cerebrovascular responses of developing animals to dopamine infusions. We studied eight near-term and eight preterm chronically catheterized unanesthetized fetal sheep. We measured cerebral blood flow and calculated cerebral vascular resistance (CVR) at baseline and during dopamine infusion at 2.5, 7.5, 25, and 75 g ⅐ kg Ϫ1 ⅐ min Ϫ1 . In preterm fetuses, MAP increased only at 75 g ⅐ kg Ϫ1 ⅐ min Ϫ1 (25 Ϯ 5%), whereas in near-term fetuses MAP increased at 25 g ⅐ kg Ϫ1 ⅐ min Ϫ1 (28 Ϯ 4%) and further at 75 g ⅐ kg Ϫ1 ⅐ min Ϫ1 (51 Ϯ 3%). Dopamine infusion was associated with cerebral vasoconstriction in both groups. At 25 g ⅐ kg Ϫ1 ⅐ min Ϫ1 , CVR increased 77 Ϯ 51% in preterm fetuses and 41 Ϯ 11% in near-term fetuses, and at 75 g ⅐ kg Ϫ1 ⅐ min Ϫ1 , CVR increased 80 Ϯ 33% in preterm fetuses and 83 Ϯ 21% in near-term fetuses. We tested these responses to dopamine in 11 additional near-term fetuses under ␣-adrenergic blockade (phenoxybenzamine, n ϭ 5) and under dopaminergic D1-receptor blockade (SCH-23390, n ϭ 6). Phenoxybenzamine completely blocked dopamine's pressor and cerebral vasoconstrictive effects, while D1-receptor blockade had no effect. Therefore, in unanesthetized developing fetuses, dopamine infusion is associated with cerebral vasoconstriction, which is likely an autoregulatory, ␣-adrenergic response to an increase in blood pressure.brain; fetus; vasoconstriction BLOOD PRESSURE IS AN IMPORTANT "vital sign" that is carefully monitored in preterm infants. Hypotension is believed to be an important risk factor for cerebral ischemic injury and intracranial hemorrhage, and so preterm infants often receive volume expanders (even in the absence of hypovolemia) and/or inotropic drugs (most commonly, dopamine) to increase blood pressure (1, 18). However, concern has been raised about whether these management practices could be detrimental (29). Seri et al. (25) recently reported that low-dose dopamine infusion does not affect cerebral blood flow (CBF) velocity in sick, normotensive preterm infants. However, little else is known about the cerebrovascular responses of the developing brain to intravenous dopamine and/or acute increases in blood pressure. In adult animals, intravenous dopamine at moderate doses causes cerebral vasodilation, presumably by stimulation of specific vasodilatory dopaminergic receptors (32). In immature animals, dopamine is a less effective inotropic agent, presumably because of immaturity of cardiac ␤ 1 -adrenergic receptors. Minimal cerebral vasodilatory, or possibly vasoconstrictive, effects might therefore be expected at low or moderate dopamine doses, because development of vascular dopaminergic receptors is also likely to be incomplete, particularly compared with ␣-adrenergic receptors (8,12,30,31)....

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“…Padbury et al 12 compared the clinical responses with plasma dopamine concentration and compared dopamine pharmacokinetics in 14 infants of different gestational ages (range: 27 to 42 weeks) or different clinical conditions. Dopamine infusion was increased stepwise from 1 to 2, or 2 to 4, or 4 to 8 mg/kg per min.…”

mentioning

confidence: 99%

Clinical pharmacology of dobutamine and dopamine in preterm neonates

Pacifici¹

2014

Medical Express

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Dobutamine is a b 1 selective stimulant. b Receptor agonists are used to stimulate the rate and the force of cardiac contraction. The chronotropic effect is useful for the treatment of arrhythmias whereas the inotropic effect is useful to augment the myocardial contractility. Dobutamine is about four times as potent as dopamine in stimulating myocardial contractility in low concentrations and increases left ventricular output in the hypotensive preterm infants. Dobutamine possesses a center of asymmetry. The (2 )-isomer of dobutamine is a potent agonist of a 1 receptors and is capable of causing marked pressor responses. In contrast, (þ)-dobutamine is a potent a 1 receptor antagonist which can block the effects of (2)-dobutamine. Dobutamine is relatively cardioselective at dosages used in clinical practice with its main action being on b 1 -adrenergic receptors. Dobutamine and dopamine undergo intense metabolism in neonates where they are conjugated with sulphate and O-methylated. The clearance and the half-life of dobutamine and dopamine range over one order of magnitude in neonates. Dopamine is widely used to increase blood pressure, cardiac output, urine output and peripheral perfusion in neonates with shock and cardiac failure. Dopamine is more effective than dobutamine in the short-term treatment of systemic hypotension in preterm infants. High doses of dopamine cause vasoconstriction, increase systemic vascular resistance, and, eventually, decrease renal blood flow. Treatment with dobutamine is associated with a significantly greater increase in left ventricular output in the single study reporting that outcome. Dobutamine is indicated for the short-term treatment of cardiac decompensation.

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Pharmacokinetics of dopamine in critically ill newborn infants

Cited by 53 publications

References 10 publications

Effect of dopamine on peripheral perfusion in very-low-birth-weight infants during the transitional period

Effect of dopamine on peripheral perfusion in very-low-birth-weight infants during the transitional period

Cerebrovascular effects of intravenous dopamine infusions in fetal sheep

Clinical pharmacology of dobutamine and dopamine in preterm neonates

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