Trends in Pharmacotherapy for Neonatal Hypotension

Rios, Danielle R.; Moffett, Brady S.; Kaiser, Jeffrey R.

doi:10.1016/j.jpeds.2014.06.009

Cited by 55 publications

(41 citation statements)

References 29 publications

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“…A recent multicentre (114 neonatal intensive care units) survey in Australia/New Zealand27 and a study for determining the trend in pharmacotherapy for neonatal hypotension in the USA28 show that different neonatal units have different protocols in the management of preterm infants with hypotension, and there has been a definitive trend for more liberal use of systemic corticosteroids in recent years. All randomised controlled studies reveal that treated patients respond readily to corticosteroids and inotropes can be quickly weaned off within 72 hours 17–19.…”

Section: Management Of Refractory Hypotensionmentioning

confidence: 99%

Adrenocortical insufficiency and refractory hypotension in preterm infants

2016

Arch Dis Child Fetal Neonatal Ed

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Preterm, very low birthweight (VLBW) infants are prone to life-threatening hypotension secondary to hypothalamic-pituitary-adrenal axis immaturity, resulting in adrenocortical insufficiency. Clinical presentations of inotrope-resistant refractory hypotension are usually evident, but interpretation of serum cortisol may pose much difficulty to front-line neonatologists. This review examines the salient pathophysiology of adrenocortical insufficiency in the immediate postnatal period, characterises its endocrinological abnormalities, and describes the typical and variant clinical presentations. Based on existing evidence, a practical scheme is proposed for logical interpretation of circulating cortisol levels and management of inotrope-resistant refractory hypotension in VLBW infants.

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Section: Management Of Refractory Hypotensionmentioning

confidence: 99%

Adrenocortical insufficiency and refractory hypotension in preterm infants

2016

Arch Dis Child Fetal Neonatal Ed

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“…However, the causes for neonatal hypotension still remain unclear. Dopamine plays a key role in maintaining cardiovascular homeostasis and is the most frequently prescribed medication for neonatal hypotension because of its inotropic and vasoconstrictive actions [13][14]. Therefore, it is significant to measure baseline and therapeutic dopamine levels for the diagnosis and the management of hypotension in preterm infants.…”

Section: Measurement Of Endogenous Plasma Dopamine Levelsmentioning

confidence: 99%

Quantitative determination of dopamine in human plasma by a highly sensitive LC–MS/MS assay: Application in preterm neonates

Zhang

Chow

et al. 2016

Journal of Pharmaceutical and Biomedical Analysis

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“…20 We recently showed that vasopressin use has increased in NICUs during the last decade. 10 From the results of this small pilot trial, it is encouraging that vasopressin was as efficacious as dopamine in treating hypotension in ELBW infants, perhaps may have some pulmonary benefits, and did not cause tachycardia.…”

Section: Discussionmentioning

confidence: 89%

“…Unfortunately, when more than one agent is used, mortality may be higher in hypotensive ELBW infants. 10 Dopamine has variable dose-related activation of D 1 , D 2 , β 1 , β 2 , α 1 , and α 2 receptors, 11 but it is unclear whether similar receptor activation occurs in ELBW infants. Moreover, dopamine increases pulmonary arterial pressure 12 and inhibits thyrotropin, growth hormone, and gonadotropins.…”

mentioning

confidence: 99%

Vasopressin versus Dopamine for Treatment of Hypotension in Extremely Low Birth Weight Infants: A Randomized, Blinded Pilot Study

Rios

Kaiser

2015

The Journal of Pediatrics

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Objective To evaluate vasopressin vs dopamine as initial therapy in ELBW infants with hypotension during the first 24 hours of life. Study design Hypotensive ELBW infants ≤ 30 weeks’ gestation and ≤ 24 hours old randomly received treatment with vasopressin or dopamine in a blinded fashion. Normotensive infants not receiving vasopressor support served as a comparison group. Results Twenty hypotensive ELBW infants received vasopressin (n=10) or dopamine (n=10), and 50 were enrolled for comparison. Mean gestational age was 25.6 ± 1.4 weeks and birth weight 705 ± 154 g. Response to vasopressin paralleled that of dopamine in time to adequate mean BP (Kaplan-Meier curve, p=0.986); 90% of infants in each treatment group responded with adequate BP. The vasopressin group received fewer doses of surfactant (p<0.05), had lower PaCO2 values (p<0.05), and were not tachycardic (p<0.001) during vasopressin administration, compared with the dopamine group. Conclusions Vasopressin in ELBW infants as the initial agent for early hypotension appeared safe. This pilot study supports a larger randomized controlled trial of vasopressin vs dopamine therapy in ELBW infants with hypotension.

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Trends in Pharmacotherapy for Neonatal Hypotension

Cited by 55 publications

References 29 publications

Adrenocortical insufficiency and refractory hypotension in preterm infants

Adrenocortical insufficiency and refractory hypotension in preterm infants

Quantitative determination of dopamine in human plasma by a highly sensitive LC–MS/MS assay: Application in preterm neonates

Vasopressin versus Dopamine for Treatment of Hypotension in Extremely Low Birth Weight Infants: A Randomized, Blinded Pilot Study

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