Dopamine therapy is associated with impaired cerebral autoregulation in preterm infants

Eriksen, Vibeke R.; Hahn, Gitte Holst; Greisen, Gorm

doi:10.1111/apa.12817

Cited by 45 publications

(42 citation statements)

References 29 publications

(32 reference statements)

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“…In this study, however, infants with an HSDA received inotropes more often than controls. Dopamine administration has previously been associated with impaired cerebrovascular autoregulation in preterm infants [16] and a mismatch between cerebral perfusion and oxygenation in newborn piglets [17]. We speculate that the higher rate of administration of dopamine might have contributed to their findings of decreased cerebral rSO 2 in the presence of an HSDA, in contrast to all previous reports.…”

Section: Discussioncontrasting

confidence: 58%

A Hemodynamically Significant Patent Ductus Arteriosus Does Not Affect Cerebral or Renal Tissue Oxygenation in Preterm Infants

Laan¹,

Roofthooft

Fries

et al. 2016

Neonatology

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Background: Patent ductus arteriosus (PDA) is common in preterm infants and is associated with significant morbidity. To determine whether the PDA is hemodynamically significant (HSDA), several echocardiographic parameters have been suggested, including retrograde diastolic blood flow in the descending aorta (Dao). Objective: To assess the impact ofan HSDA, including retrograde diastolic flow in the Dao, on regional tissue oxygen saturation (rSO₂) and extraction measured by near-infrared spectroscopy (NIRS). Methods: This is a prospective observational cohort study in which we included preterm infants (GA <32 weeks) who underwent echocardiographic screening because of clinical signs of an HSDA within 2 weeks after birth. We measured cerebral and renal rSO₂ on the day of echocardiography. HSDA was diagnosed if left-to-right shunting through the PDA was accompanied by left atrial-to-aortic root ratio >1.4 and/or left pulmonary artery end-diastolic flow velocity >0.2 m/s and/or retrograde diastolic blood flow in the Dao. Results: Forty-nine infants were included, with a median GA of 27.6 weeks (IQR: 26.1-29.0), birth weight of 980 g (IQR: 800-1,200), and postnatal age of 77 h (IQR: 70-107). Infants with a closed duct (n = 11), a non-HSDA (n = 18), and an HSDA (n = 20) had similar cerebral and renal NIRS measurements. Retrograde diastolic blood flow in the Dao, present in 11 infants with PDA, also did not affect cerebral and renal NIRS measurements. Conclusion: In preterm infants with clinical signs of an HSDA within 2 weeks after birth, cerebral and renal oxygen saturation and extraction are not affected by an HSDA or by retrograde diastolic blood flow in the Dao.

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Section: Discussioncontrasting

confidence: 58%

A Hemodynamically Significant Patent Ductus Arteriosus Does Not Affect Cerebral or Renal Tissue Oxygenation in Preterm Infants

Laan¹,

Roofthooft

Fries

et al. 2016

Neonatology

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“…Its use, however, is concerning, as it has been shown to have variable effects on outcome and possibly leads to neurodevelopmental delays [1,18,29,33]. Dopamine therapy, in particular the first-line agent used in the study center, has been shown to lead to decreased end-organ perfusion, failure to restore cerebral autoregulation, and failure to increase cerebral perfusion in the setting of increased BP [19,26,34,35,36]. In adult and pediatric data, dopamine use as compared to norepinephrine or epinephrine therapy leads to higher mortality rates [37,38].…”

Section: Discussionmentioning

confidence: 99%

“…Aggressive hypotension therapy may lead to worse outcomes (mortality and IVH) than allowing permissive hypotension in patients with no signs of systemic hypoperfusion [24,25]. Vasopressor therapy is also controversial as some studies indicate that it is independently associated with impaired cerebral autoregulation and brain injury [4,26,27]. This underlines the need to adequately define the BP threshold that will lead to cerebral injury in order to target therapy.…”

Section: Introductionmentioning

confidence: 99%

Hypotension and Adverse Outcomes in Prematurity: Comparing Definitions

Peter

Gandy

Hoffman³

2016

Neonatology

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Background: In the premature neonate, there is no consensus regarding normal blood pressure (BP). The most common definition used is a mean arterial BP (MAP) less than the gestational age (GA); however, studies indicate that the neuroprotective mechanism of autoregulation is lost below a MAP of 30 mm Hg. Objective: To determine whether hypotension defined as MAP <30 mm Hg or MAP less than the infant's GA better predicts adverse outcomes of intraventricular hemorrhage (IVH) and death. Study Design: For this retrospective study, demographic, clinical, and BP data in epochs of 12 h were collected during the first 72 h of life in 188 subjects 24-28 weeks of gestation. For each definition, outcomes of severe IVH (grade 3 or 4), death, or the composite outcome of either were evaluated using bivariate testing. Logistic regression determined independent predictors of composite outcome of death and/or grade 3 or 4 IVH. Results: Hypotension by either definition was significant for death and the composite outcome (p < 0.0001). Only the MAP <30 mm Hg definition was associated with severe IVH (p = 0.02). On logistic regression, significant predictors of the composite outcome were GA (OR 0.59, 95% CI 0.39-0.89) and vasopressor therapy (OR 5.5, 95% CI 2-17). Conclusions: Neither definition of hypotension independently predicts adverse outcome in multivariate logistic regression. Vasopressor therapy, however, is an independent predictor of IVH and death in premature infants.

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“…It was found that treated hypotension was associated with short-and long-time morbidity, which suggests an indirect relationship between inotropes and a pressure-passive cerebral circulation (22,23). Furthermore, a direct negative influence of dopamine on CAR has been reported (24). Conversely, several studies demonstrated a protective role of inotropes by means of increasing CBF (25)(26)(27).…”

Section: Car In Preterm Infants With Necmentioning

confidence: 99%

Assessing cerebrovascular autoregulation in infants with necrotizing enterocolitis using near-infrared spectroscopy

et al. 2015

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Dopamine therapy is associated with impaired cerebral autoregulation in preterm infants

Abstract: Dopamine therapy was associated with decreased CA in preterm infants. We were unable to determine whether dopamine directly impaired CA or was merely an indicator of illness.

Cited by 45 publications

References 29 publications

A Hemodynamically Significant Patent Ductus Arteriosus Does Not Affect Cerebral or Renal Tissue Oxygenation in Preterm Infants

A Hemodynamically Significant Patent Ductus Arteriosus Does Not Affect Cerebral or Renal Tissue Oxygenation in Preterm Infants

Hypotension and Adverse Outcomes in Prematurity: Comparing Definitions

Assessing cerebrovascular autoregulation in infants with necrotizing enterocolitis using near-infrared spectroscopy

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