Cardiac output in newborn infants with transient myocardial dysfunction

Walther, Frans J.; Siassi, Bijan; Ramadan, Naglaa A.; Wu, Paul Y K

doi:10.1016/s0022-3476(85)80417-0

Cited by 121 publications

(61 citation statements)

References 16 publications

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“…Consistent with the maturational process, term neonates are less sensitive than preterm infants to the pressor effects of lowdose dopamine therapy. However, according to our present findings, at least on the first day of life, they still exhibit a somewhat enhanced pressor response compared with older age groups (2,35).…”

Section: Discussionsupporting

confidence: 75%

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

et al. 1993

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ABSTRACT. Effects of 2 and 4 pg/kg/min dopamine infusion on cardiovascular and renal functions, cerebral blood flow (CBF) and plasma catecholamine levels were studied in sick preterm neonates during the first four days of life. Preterm infants were found to have an enhanced responsiveness to the pressor effects of dopamine during this period. Comparison of the renal effects of 2 and 4 &kg/ min dopamine in 61 preterm infants indicate that 2 pg/kg/ min dopamine induces maximum diuresis and natriuresis during the first day of life provided that systemic blood pressure is within the predicted normal range. Although administration of 4 pg/kg/min dopamine induces further increases in blood pressure and glomerular filtration rate, urine output and sodium excretion remain similar to that on 2 pg/kg/min of the drug. These findings demonstrate that the direct tubular effects of dopamine play an important role in the diuretic and natriuretic action of the drug in the one-day old preterm infant. In five preterm neonates, changes in CBF transiently paralleled the dopamine-induced alterations in systemic blood pressure indicating that autoregulation of CBF is impaired but not completely ineffective in the one-day old preterm infant. In eight term neonates, increases in blood pressure had no effect on CBF. Measurements of plasma dopamine and norepinephrine levels in 14 preterm neonates and five children suggest that decreased metabolism of dopamine may contribute to the enhanced pressor responsiveness to dopamine in sick preterm infants. Based on these findings, we propose that dopamine should be started at 2 pg/kg/min in the hypotensive and/or oliguric preterm infant, and that the dose should be increased in a stepwise manner tailored to the cardiovascular and renal response to the patient. (Pediatr Res 34: 742449,1993) Abbreviations ACA, anterior cerebral artery ANOVA, analysis of variance CBF, cerebral blood flow 6, creatinine clearance DA, dopamine (study group) DBP, diastolic blood pressure EDFV, end-diastolic flow velocity ESFV, end-systolic flow velocity CFR, glomerular filtration rate

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Section: Discussionsupporting

confidence: 75%

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

et al. 1993

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“…The clinical picture varies from brady-or tachycardia to cardiogenic shock (3,4), and the transient abnormalities described include hypotension, myocardial ischemia, mitral and/or tricuspid regurgitation, and pulmonary hypertension (5,6). During the first postnatal hours, there is an inverse relationship between tricuspid velocity and age (7), and a relationship between low alveolar oxygen tension and increased pulmonary vascular resistance (8).…”

mentioning

confidence: 99%

Reduced Left Ventricular Function in Hypoxemic Newborn Pigs: A Strain Doppler Echocardiographic Study

Børke¹,

Edvardsen²,

Fugelseth

et al. 2006

Pediatr Res

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Myocardial dysfunction, hypotension, and increased pulmonary artery pressure are induced by asphyxia in neonates. We sought to define left ventricular (LV) systolic function by measuring longitudinal and radial contraction by strain Doppler echocardiography (SDE) in hypoxemic newborn pigs. Hypoxemia was induced in 11 anesthetized and instrumented newborn pigs by ventilation with 8% O 2 in nitrogen. When mean arterial blood pressure (BP) decreased to 15 mm Hg or arterial base excess reached Ϫ20 mmol/L or less, the pigs were reoxygenated and ventilated for 150 min. Echocardiography was performed at baseline and during hypoxemia and reoxygenation. Baseline measurements of myocardial peak systolic strain demonstrated normal longitudinal shortening and radial thickening. During hypoxemia, systolic longitudinal shortening in the mid-posterior and septal segments changed to systolic stretching. Peak strain in the mid-lateral and anterior segments decreased but without signs of paradox wall motion. Short-axis peak strain remained positive during hypoxemia, although the amplitude was reduced and delayed with respect to timing. In the newborn pig heart, we found a complex and heterogeneous systolic pattern with distinct regional differences during global hypoxemia. Rapid changes in LV function during hypoxemia and reoxygenation are assessable by SDE, and the results indicate that longitudinal systolic contraction is more vulnerable to hypoxemic changes than radial contraction. To explore the full picture of a global hypoxemic injury, both long-and short-axis functions have to be considered.

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“…'6 17 Any assessment must be performed before treatment as this is likely to influence the results dramatically. 18 The purpose of this study was to assess myocardial contractility and output in the first 24 hours after birth in very low birthweight infants, firstly to define a normal range and secondly to determine if cardiac dysfunction occurred in those infants who were hypotensive or acidotic, or both. and/or (b) identified as having a metabolic acidosis (defined as an arterial pH less than 7-25 and base deficit greater than 6).…”

mentioning

confidence: 99%

Echocardiographic assessment of cardiac function in shocked very low birthweight infants.

Gill

Weindling

1993

Archives of Disease in Childhood

134

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The contribution of abnormal cardiac function to hypotension and metabolic acidosis, which affect approximately 40% of ventilated very low birthweight infants in the first 24 hours after birth was assessed using M mode, two dimensional, and Doppler echocardiography in 75 very low birthweight infants during the first few hours after birth. Thirty four infants whose blood pressure was less than the 10th centile or who had a metabolic acidosis in the first 24 hours were compared with 41 who showed neither feature. The median shortening fraction was significantly lower in the hypotensive/acidotic (shocked) group than in the controls. In 16 of 34 (47%) shocked infants left ventricular contractility and output were significantly worse than in the control subjects. One and five minute Apgar scores were also significandy lower in the shock group when compared with controls.Cardiac dysfunction was an important feature in the shocked very low birthweight infants. It is speculated that volume expansion may not always be the most appropriate first line treatment for such infants.

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Cardiac output in newborn infants with transient myocardial dysfunction

Cited by 121 publications

References 16 publications

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

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

Reduced Left Ventricular Function in Hypoxemic Newborn Pigs: A Strain Doppler Echocardiographic Study

Echocardiographic assessment of cardiac function in shocked very low birthweight infants.

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