Randomized trial of dobutamine versus dopamine in preterm infants with low systemic blood flow

Osborn, David A; Evans, Nick; Kluckow, Martin

doi:10.1067/mpd.2002.120834

Cited by 225 publications

(202 citation statements)

References 28 publications

Supporting

Mentioning

186

Contrasting

Unclassified

Order By: Relevance

“…When comparing dopamine and dobutamine in the treatment of low SBF in 42 patients, 40% of patients did not respond at all, while dobutamine achieved better SBF increase and dopamine achieved BP increase in the others. 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.…”

Section: Discussionmentioning

confidence: 91%

“…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%

See 1 more Smart Citation

Acute hemodynamic effects of caffeine administration in premature infants

et al. 2008

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Acute hemodynamic effects of caffeine administration in premature infants

et al. 2008

View full text Add to dashboard Cite

show abstract

“…1 design to compare the effects of dopamine and dobutamine at 10 and 20 mcg/kg/min on SVC flow and blood pressure in VLBW neonates during the first postnatal day. 27 They found that dopamine improved systemic blood pressure more effectively at the two doses used, while dobutamine was better at increasing SVC flow at the two doses tested. As pharmacodynamics rather than pharmacokinetics determine the cardiovascular response to these sympathomimetic amines, a limitation of this study is the lack of a stepwise titration of these drugs in search for the optimal hemodynamic response.…”

Section: Introductionmentioning

confidence: 97%

“…bedside assessment of CBF using SVC flow measurements 7,27 and/or NIRS. 3,5,9,22 Management of this presentation of circulatory compromise is difficult and findings in the literature are somewhat contradictory.…”

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

View full text Add to dashboard Cite

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.

show abstract

“…1 In preterm infants, the complex physiology of the postnatal transition and the inherent immaturity of the cardiopulmonary and other organ systems present the most important challenge of establishing normative values, as continuous blood pressure monitoring in itself is insufficient to identify abnormal organ blood flow and tissue oxygen delivery in this patient population. 2 Furthermore, although there is an abundance of evidence showing improvement in blood pressure and other cardiovascular parameters, such as cardiac output, cerebral and non-vital organ blood flow and renal function, when 'hypotension' is treated during postnatal transition, [3][4][5][6][7][8][9][10] there are no data showing that treatment results in improvements in long-term outcome.…”

Section: Introductionmentioning

confidence: 99%

Definition of hypotension and assessment of hemodynamics in the preterm neonate

2009

View full text Add to dashboard Cite

The complexity of postnatal cardiovascular transition has only recently been better appreciated in the very low birth weight neonate. As blood pressure in itself poorly represents systemic blood flow, especially when the fetal channels are open and the developmentally regulated vital organ assignment may not have been completed, efforts to measure systemic blood flow have resulted in a novel, yet incomplete, understanding of the principles and clinical relevance of cardiovascular adaptation during postnatal transition in this patient population. This article describes the definition of hypotension based on the principles of cardiovascular physiology, and reviews the tools available to the clinician and researcher at the bedside to examine the complex relationship among blood pressure, systemic and organ blood flow, and tissue oxygen delivery and oxygen demand in vital and non-vital organs in the very low birth weight neonate. Only after gaining an insight into these complex relationships and processes will we be able to design clinical trials of selected treatment modalities targeting relevant patient sub-populations for the management of neonatal cardiovascular compromise. Only clinical trials based on a solid understanding of developmental cardiovascular physiology tailored to the appropriate patient sub-population hold the promise of being effective and practical, and can lead to improvements in both hemodynamic parameters and clinically relevant outcome measures.

show abstract

Randomized trial of dobutamine versus dopamine in preterm infants with low systemic blood flow

Cited by 225 publications

References 28 publications

Acute hemodynamic effects of caffeine administration in premature infants

Acute hemodynamic effects of caffeine administration in premature infants

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

Definition of hypotension and assessment of hemodynamics in the preterm neonate

Contact Info

Product

Resources

About