Mean arterial blood pressure and neonatal cerebral lesions.

Miall‐Allen, V M; Vries, Linda S. de; Whitelaw, A

doi:10.1136/adc.62.10.1068

Cited by 342 publications

(191 citation statements)

References 5 publications

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“…In preterm infants it is associated with the development of intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL) and poor neurodevelopmental outcomes. [1][2][3][4] Inadequate perfusion as a complication of sepsis, respiratory failure, severe birth depression or persistent pulmonary hypertension, is also detrimental to the critically ill term infant. While the etiologies of hypotension are multifactorial, there may exist a subset of infants with adrenal insufficiency manifesting as hypotension refractory to standard therapy.…”

Section: Introductionmentioning

confidence: 99%

Hydrocortisone administration for the treatment of refractory hypotension in critically ill newborns

et al. 2008

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Objective: The purpose of this observation was to evaluate the safety and efficacy of hydrocortisone (HC) for the treatment of refractory hypotension in term and preterm infants. A secondary purpose was to determine the utility of serum cortisol concentrations in predicting the response to treatment.Study Design: This is a retrospective observational study of 117 infants treated with a standardized HC protocol for refractory hypotension. Refractory hypotension was defined as a mean arterial pressure (MAP) less than the gestational age (GA) despite a total inotrope dose of 20 mg per kg per min. Baseline serum cortisol concentrations were determined prior to treatment with stress dose HC.Result: Treatment with HC increased the MAP at 2, 6, 12 and 24 h after initiation, decreased the total inotrope dose at 6, 12 and 24 h, and was associated with resolution of oliguria. There was no correlation between the pretreatment baseline cortisol concentration and GA, birth weight or the response to treatment. The incidence of grades III to IV intraventricular hemorrhage, periventricular leukomalacia, bacterial or fungal sepsis and spontaneous intestinal perforation (SIP) after HC treatment was similar to institutional historic controls prior to institution of this standardized HC protocol.Conclusion: HC treatment was associated with a rapid resolution of cardiovascular compromise. The incidence of significant side effects was similar to that in previously published reports, including a comparable incidence of SIP. On the basis of our results, measuring baseline serum cortisol concentration to guide the management of refractory hypotension is unwarranted.

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Section: Introductionmentioning

confidence: 99%

Hydrocortisone administration for the treatment of refractory hypotension in critically ill newborns

et al. 2008

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“…Indeed, several studies have found an association between hypotension 9-12 and alterations in CBF [13][14][15] and central nervous system morbidity (IVH, PVL) and neurodevelopmental outcome. [16][17][18] However, it is important to note that, although data on an association between hypotension and/or abnormal CBF and short-and long-term central nervous system morbidity are abundant, [8][9][10][11][12][13][14][15][16][17][18] very little data are available demonstrating a causative relationship among these factors.…”

Section: Introductionmentioning

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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“…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).…”

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confidence: 99%

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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Mean arterial blood pressure and neonatal cerebral lesions.

Cited by 342 publications

References 5 publications

Hydrocortisone administration for the treatment of refractory hypotension in critically ill newborns

Hydrocortisone administration for the treatment of refractory hypotension in critically ill newborns

Management of hypotension and low systemic blood flow in the very low birth weight neonate during the first postnatal week

Cerebrovascular effects of intravenous dopamine infusions in fetal sheep

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