Response to dobutamine and dopamine in the hypotensive very preterm infant.

Rozé, Jean Christophe; Tohier, C; Maingueneau, C; LeFevre, Mike; Mouzard, A

doi:10.1136/adc.69.1_spec_no.59

Cited by 186 publications

(142 citation statements)

References 29 publications

(3 reference statements)

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“…12 Dopamine was more effective than dobutamine in raising BP in 20 hypotensive infants however dopamine did not increase LVCO. 13 Both dopamine and dobutamine failed to increase myocardial contractility in 106 infants with low SBF in the first day of life, with dopamine increasing LV stress. 14 Milrinone failed to increase right ventricular CO (RVCO) in a prospective trial.…”

Section: Discussionmentioning

confidence: 97%

“…Previous studies describing the pharmacological effects of dopamine, dobutamine, milrinone, epinephrine or hydrocortisone have not shown consistent changes in the LVCO and SV. [9][10][11][12][13][14][15][16] Hydrocortisone, 9 commonly used to increase BP in infants unresponsive to dopamine, failed to increase LVCO significantly in a study of 15 hypotensive infants. The hemodynamic effect of dopamine has been examined in several studies: A trend of increasing RVCO, did not reach statistical significance, with significant increase of the shortening fraction in 8 hypotensive premature infants; 10 in 50 hypotensive patients treated with dopamine, LVCO dropped in 40, compared to 10 others in whom LVCO increased 11: BP did increase in the low LVCO group, with concomitant increase in the SVR.…”

Section: Discussionmentioning

confidence: 99%

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Acute hemodynamic effects of caffeine administration in premature infants

et al. 2008

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Objective: Administration of caffeine citrate (caffeine) has been a central component of the treatment of apnea of prematurity. However, given its multiple pharmacologic effects, caffeine might be expected to produce hemodynamic changes in heart rate, stroke volume, cardiac output and vascular resistance.Study Design: In this prospective observational study, we report the hemodynamic effects of intravenous caffeine administration in a population of premature infants who received caffeine to correct or prevent apnea of prematurity.Methods: Hemodynamic effects of caffeine were determined in 31 infants. Stroke volume was measured via echocardiogram, using velocity time integral at the aortic root diameter. Statistically univariate analyses were performed parametrically using paired t-test and nonparametrically (sign test). Multivariate linear regression models were used to identify subgroup covariate effects.Results: After intravenous caffeine, cardiac index increased in 31 of 31 trials, by an average of 14.6 ± 16.3% (s.d.); stroke volume increased in 24 of 31 trials, by 7.8±12.2%; heart rate increased in 28 of 31 trials by 7.7 ± 7.2 beats per min; and blood pressure increased in 25 of 31 trials, by 4.1±5.8 mm Hg (all P<0.001). Multivariate linear regression revealed no significant effect of dose, birth weight, gestational age or postnatal age.Conclusions: Intravenous caffeine consistently increases cardiac output and blood pressure in relatively stable premature infants, when given to treat or prevent apnea of prematurity. We speculate that there may be a role for caffeine in the hemodynamic treatment of hypotensive/ hypoperfused infants.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Acute hemodynamic effects of caffeine administration in premature infants

et al. 2008

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“…23,24 The cardiovascular response is influenced by several factors (state of cardiovascular adrenergic receptor expression, etc) regulated by the level of maturity and disease severity. 1 tailored to address both components of the cardiovascular compromise (vasodilation and potential myocardial dysfunction).…”

Section: Vasodilation and Hyperdynamic Myocardial Functionmentioning

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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“…On the other hand, dobutamine is associated with a variable decrease in peripheral vascular resistance, mediated through β2 peripheral adrenergic and dopaminergic vascular receptors, resulting in peripheral vasodilatation. This could explain an increased FVD due to dobutamine treatment (23)(24)(25). However, some of our children also received dopamine.…”

Section: Discussionmentioning

confidence: 82%