Neonatal blood pressure support: the use of inotropes, lusitropes, and other vasopressor agents.

A solid understanding of the mechanisms of action of cardiovascular medications used in clinical practice along with efforts to develop comprehensive hemodynamic monitoring systems to improve the ability to accurately identify the underlying pathophysiology of cardiovascular compromise are essential in the management of neonates with shock. This article reviews the mechanisms of action of the most frequently used cardiovascular medications in neonates. Because of paucity of data from controlled clinical trials, evidence-based recommendations for the clinical use of these medications could not be made. Careful titration of the given medication with close monitoring of the cardiovascular response might improve the effectiveness and decrease the risks associated with administration of these medications.

[1]  M. Schreiber,et al.  Effect of high-dose dopamine on urine output in newborn infants. , 1986 .

[2]  T. Tulassay,et al.  Cardiovascular response to dopamine in hypotensive preterm neonates with severe hyaline membrane disease , 1984, European Journal of Pediatrics.

[3]  F. Wong,et al.  Dopamine therapy promotes cerebral flow-metabolism coupling in preterm infants , 2009, Intensive Care Medicine.

[4]  I. Seri,et al.  Cardiovascular, renal, and endocrine actions of dopamine in neonates and children. , 1995, The Journal of pediatrics.

[5]  Q. Han,et al.  Emerging concepts and therapeutic implications of beta-adrenergic receptor subtype signaling. , 2005, Pharmacology & therapeutics.

[6]  J. Tobias,et al.  Vasopressin: Applications in Clinical Practice , 2004, Journal of intensive care medicine.

[7]  J. Leighton,et al.  Supranormal Cardiac Output in the Dopamine- and Dobutamine-Dependent Preterm Infant , 1997, Pediatric Cardiology.

[8]  Juerg Schwitter,et al.  ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 , 2010, European journal of heart failure.

[9]  A. Fanaroff,et al.  Treated Hypotension Is Associated With Neonatal Morbidity and Hearing Loss in Extremely Low Birth Weight Infants , 2006, Pediatrics.

[10]  J. Rozé,et al.  Dopamine effects on pulmonary artery pressure in hypotensive preterm infants with patent ductus arteriosus. , 2002, The Journal of pediatrics.

[11]  W. Gersony,et al.  Intravenous arginine-vasopressin in children with vasodilatory shock after cardiac surgery. , 1999, Circulation.

[12]  N. Subhedar,et al.  Right Ventricular Performance in Hypotensive Preterm Neonates Treated with Dopamine , 2002, Pediatric Cardiology.

[13]  W. Toller,et al.  Levosimendan, a New Inotropic and Vasodilator Agent , 2006, Anesthesiology.

[14]  J. Rozé,et al.  Response to dobutamine and dopamine in the hypotensive very preterm infant. , 1993, Archives of disease in childhood.

[15]  A. Walker,et al.  Hypotensive Extremely Low Birth Weight Infants Have Reduced Cerebral Blood Flow , 2004, Pediatrics.

[16]  A. Rodríguez-Núñez,et al.  Rescue treatment with terlipressin in children with refractory septic shock: a clinical study , 2006, Critical care.

[17]  Heather M. O'Leary,et al.  Elevated Cerebral Pressure Passivity Is Associated With Prematurity-Related Intracranial Hemorrhage , 2009, Pediatrics.

[18]  A. Plessis.  The Role of Systemic Hemodynamic Disturbances in Prematurity-Related Brain Injury: , 2009 .

[19]  K. Watterberg,et al.  Relative adrenal insufficiency in the preterm and term infant , 2009, Journal of Perinatology.

[20]  Robert G. Johnson.  Pharmacology of the Cardiac Sarcoplasmic Reticulum Calcium ATPase‐Phospholamban Interaction , 1998, Annals of the New York Academy of Sciences.

[21]  K. Farrow,et al.  Phosphodiesterases: emerging therapeutic targets for neonatal pulmonary hypertension. , 2011, Handbook of experimental pharmacology.

[22]  M. Kluckow,et al.  Randomized trial of dobutamine versus dopamine in preterm infants with low systemic blood flow. , 2002, The Journal of pediatrics.

[23]  N. Voelkel,et al.  Vasopressin-induced pulmonary vasodilation in rats. , 1989, The American journal of physiology.

[24]  I. Seri,et al.  Chapter 8 – Clinical Presentations of Neonatal Shock: The VLBW Infant during the First Postnatal Day , 2008 .

[25]  P. Tourneux,et al.  Hypotension in preterm infants with significant patent ductus arteriosus: effects of dopamine. , 2008, The Journal of pediatrics.

[26]  John A Kellum,et al.  Use of vasopressor agents in critically ill patients , 2002, Current opinion in critical care.

[27]  A. Hoes,et al.  Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. , 2005, European heart journal.

[28]  V. D’orio,et al.  The use of low doses of dopamine in intensive care medicine. , 1984, Archives internationales de physiologie et de biochimie.

[29]  H. C. Hartzell,et al.  Developmental Changes in Modulation of Calcium Currents of Rabbit Ventricular Cells by Phosphodiesterase Inhibitors , 1994, Circulation.

[30]  R. Lefkowitz,et al.  Regulation of β-Adrenergic Receptors by Steroid Hormones , 1984 .

[31]  L. A. Bonet,et al.  ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 , 2010, European journal of heart failure.

[32]  C. Cole.  Chapter 10 – The Preterm Neonate with Relative Adrenal Insufficiency and Vasopressor-resistant Hypotension , 2008 .

[33]  I. Seri,et al.  Management of hypotension and low systemic blood flow in the very low birth weight neonate during the first postnatal week , 2006, Journal of Perinatology.

[34]  S. Abbasi,et al.  Regional hemodynamic effects of dopamine in the sick preterm neonate. , 1998, The Journal of pediatrics.

[35]  T. Tulassay,et al.  Developmental Regulation of the Inhibitory Effect of Dopamine on Prolactin Release in the Preterm Neonate , 1998, Neonatology.

[36]  I. Seri,et al.  Cardiovascular effects of hydrocortisone in preterm infants with pressor-resistant hypotension. , 2001, Pediatrics.

[37]  F. Pulzer,et al.  Cardiovascular impact of dobutamine in neonates with myocardial dysfunction. , 2007, Early Human Development.

[38]  A. Aperia.  Intrarenal dopamine: a key signal in the interactive regulation of sodium metabolism. , 2000, Annual review of physiology.

[39]  G. Greisen.  Chapter 2 – Autoregulation of Vital and Nonvital Organ Blood Flow in the Preterm and Term Neonate , 2008 .

[40]  P. McNamara,et al.  Use of targeted neonatal echocardiography to prevent postoperative cardiorespiratory instability after patent ductus arteriosus ligation. , 2012, The Journal of pediatrics.

[41]  I. Seri,et al.  Changes in myocardial function and hemodynamics after ligation of the ductus arteriosus in preterm infants. , 2007, The Journal of pediatrics.

[42]  I. Seri,et al.  Chapter 1 – Etiology, Pathophysiology, and Phases of Neonatal Shock , 2008 .

[43]  W. Moosbauer,et al.  Use of levosimendan, a new inodilator, for postoperative myocardial stunning in a premature neonate , 2007, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[44]  F. Cabañas,et al.  Dopamine Versus Epinephrine for Cardiovascular Support in Low Birth Weight Infants: Analysis of Systemic Effects and Neonatal Clinical Outcomes , 2006, Pediatrics.

[45]  Istvan Seri,et al.  Effects of Low-Dose Dopamine Infusion on Cardiovascular and Renal Functions, Cerebral Blood Flow, and Plasma Catecholamine Levels in Sick Preterm Neonates , 1993, Pediatric Research.

[46]  I. Seri,et al.  Hemodynamic monitoring in neonates: advances and challenges , 2010, Journal of Perinatology.

[47]  A. Atz,et al.  Milrinone: systemic and pulmonary hemodynamic effects in neonates after cardiac surgery. , 1995, Critical care medicine.

[48]  R. Polin,et al.  Hemodynamics and Cardiology , 2008 .

[49]  T. Tulassay,et al.  Effect of low-dose dopamine infusion on prolactin and thyrotropin secretion in preterm infants with hyaline membrane disease. , 1985, Biology of the neonate.

[50]  A. Zwinderman,et al.  Is hypotension a major risk factor for neurological morbidity at term age in very preterm infants? , 2003, Early human development.

[51]  N. Kim,et al.  Mechanisms of blood pressure increase induced by dopamine in hypotensive preterm neonates , 1999, Archives of disease in childhood. Fetal and neonatal edition.

[52]  K. Morgan,et al.  The cellular basis of contraction and relaxation in cardiac and vascular smooth muscle. , 1991, American heart journal.

[53]  J. Padbury,et al.  Dobutamine pharmacokinetics and cardiovascular responses in critically ill neonates. , 1992, Pediatrics.

[54]  F. Cabañas,et al.  Acute Effects of Levosimendan on Cerebral and Systemic Perfusion and Oxygenation in Newborns: An Observational Study , 2010, Neonatology.

[55]  M. Heymann,et al.  Development of cardiovascular responses to autonomic blockade in intact fetal and neonatal lambs. , 1973, Biology of the neonate.

[56]  M. Kluckow,et al.  Randomized trial of milrinone versus placebo for prevention of low systemic blood flow in very preterm infants. , 2009, The Journal of pediatrics.

[57]  M. Endoh.  The therapeutic potential of novel cardiotonic agents , 2003, Expert opinion on investigational drugs.

[58]  I. Seri,et al.  Systemic and cerebral hemodynamics during the transitional period after premature birth. , 2009, Clinics in perinatology.

[59]  L. Gortner,et al.  Vasopressin in catecholamine‐refractory shock in children , 2007, Anaesthesia.

[60]  F. Cabañas,et al.  Early Systemic Hypotension and Vasopressor Support in Low Birth Weight Infants: Impact on Neurodevelopment , 2009, Pediatrics.

[61]  S. Abbasi,et al.  Regional Hemodynamic Effects of Dopamine in the Indomethacin-Treated Preterm Infant , 2002, Journal of Perinatology.

[62]  P. McNamara,et al.  Milrinone for persistent pulmonary hypertension of the newborn. , 2010, The Cochrane database of systematic reviews.

[63]  R. Ruffolo,et al.  Importance of receptor regulation in the pathophysiology and therapy of congestive heart failure. , 1986, The American journal of medicine.

[64]  L. I. Goldberg,et al.  Cardiovascular and renal actions of dopamine: potential clinical applications. , 1972, Pharmacological reviews.

[65]  J. Veldhuis,et al.  Dopamine Inhibits Growth Hormone and Prolactin Secretion in the Human Newborn , 1993, Pediatric Research.

[66]  M. Artman,et al.  Inotropic responses change during postnatal maturation in rabbit. , 1988, The American journal of physiology.

[67]  O. Pryds,et al.  The haemodynamic effects of dopamine and volume expansion in sick preterm infants. , 2000, Early human development.

[68]  D. Richardson,et al.  Variations in Prevalence of Hypotension, Hypertension, and Vasopressor Use in NICUs , 2001, Journal of Perinatology.

[69]  N. Evans.  Which inotrope for which baby? , 2005, Archives of Disease in Childhood - Fetal and Neonatal Edition.

[70]  J. Russell,et al.  Regulation of Phosphodiesterase 3 in the Pulmonary Arteries During the Perinatal Period in Sheep , 2009, Pediatric Research.

[71]  R. J. Thompson,et al.  Influence of acidosis, hypoxemia, and hypotension on neurodevelopmental outcome in very low birth weight infants. , 1995, Pediatrics.

[72]  R. Lefkowitz,et al.  Regulation of beta-adrenergic receptors by steroid hormones. , 1984, Annual review of physiology.

[73]  A. du Plessis.  The Role of Systemic Hemodynamic Disturbances in Prematurity-Related Brain Injury , 2009, Journal of child neurology.

[74]  L. Thomachot,et al.  Terlipressin as rescue therapy for refractory pulmonary hypertension in a neonate with a congenital diaphragmatic hernia. , 2011, Journal of pediatric surgery.

[75]  J. Padbury.  Neonatal dopamine pharmacodynamics: lessons from the bedside. , 1998, The Journal of pediatrics.

[76]  H. Bruining,et al.  Vasopressin deficiency contributes to the vasodilation of septic shock. , 1998, Circulation.

[77]  I. Seri,et al.  Pharmacology Review: The Use of Dobutamine in the Treatment of Neonatal Cardiovascular Compromise , 2004 .

[78]  P. Weston,et al.  Randomised trial of dopamine compared with hydrocortisone for the treatment of hypotensive very low birthweight infants , 1997, Archives of disease in childhood. Fetal and neonatal edition.

[79]  J. Padbury,et al.  Dopamine pharmacokinetics in critically ill newborn infants. , 1987, The Journal of pediatrics.

[80]  P. McNamara,et al.  Milrinone improves oxygenation in neonates with severe persistent pulmonary hypertension of the newborn. , 2006, Journal of critical care.

[81]  K. Barrington,et al.  Hypotension and shock in the preterm infant. , 2008, Seminars in fetal & neonatal medicine.

[82]  F. Gayá,et al.  Cardiovascular Support for Low Birth Weight Infants and Cerebral Hemodynamics: A Randomized, Blinded, Clinical Trial , 2005, Pediatrics.

[83]  I. Seri,et al.  Circulatory support of the sick preterm infant. , 2001, Seminars in neonatology : SN.

[84]  K. Barrington,et al.  Dopamine versus no treatment to prevent renal dysfunction in indomethacin-treated preterm newborn infants. , 2002, Cochrane Database of Systematic Reviews.