TREATMENT OF ARTERIAL HYPOTENSION IN NEWBORNS WITH EXTREMELY LOW GESTATIONAL AGE (LECTURE)

Cover Page


Cite item

Full Text

Abstract

The article explores modern ideas of how to manage premature newborns with arterial hypertension. In this population of patients, hypotension with the level of the mean blood pressure below the gestational age is considered prognostically unfavourable. Standard therapy includes volemic bolus with NaCl 0.9% and inotropic support (more frequently represented by dopamin to 10 µg/kg/min). Analysis of modern literature shows that the approach is not always successful. Arterial hypotension proper must not be the reason for therapy initiation as parallel analysis of clinical and echocardiographic signs is necessary.

Echocardiography aims at the evaluation of contractility of the myocardium and systemic blood flow and exclusion of hemodynamically significant arterial duct and pulmonary hypertension. Volemic bolus is given upon respective indications and dobutamine can be considered as the 1st line inotropic agent in the majority of cases. Early administration of hydrocortisone is reasonable in resistant hypotension.

About the authors

O. E. Mitkinov

Republican Perinatal Center

Author for correspondence.
Email: moe.68@mail.ru
Ulan-Ude, Buryatia Russian Federation

References

  1. Lyu Y., Ye X. Y., Isayama T., et al. Admission Systolic Blood Pressure and Outcomes in Preterm Infants of≤ 26 Weeks’ Gestation // American Journal of Perinatology. 2017. doi: 10.1055/s-0037–1603342.
  2. Levene M., Grove B. Development of audit measures and guidelines for good practice in the management of neonatal respiratory distress syndrome // Archives of Disease in Childhood. 1992. Т. 67. № 10. P. 1221–1227.
  3. Emery E. F., Greenough A. Non-invasive blood pressure monitoring in preterm infants receiving intensive care // Europe Journal of Pediatrics. 1992. 151 (02). P. 136–139.
  4. Takci S., Yigit S., Korkmaz A., et al. Comparison between oscillometric and invasive blood pressure measurements in critically ill premature infants // Acta Paediatrica. 2012. 101 (02). P. 132–135. doi: 10.1111/j.1651–2227.2011.02458.
  5. Northern Neonatal Nursing Initiative. Systolic blood pressure in babies of less than 32 weeks gestation in the first year of life // Archives of Disease in Childhood. Fetal Neonatal Edition. 1999. 80 (01). P. 38–42.
  6. Dempsey E. M. Challenges in Treating Low Blood Pressure in Preterm Infants // Children. 2015. Т. 2. № 2. P. 272–288. doi: 10.3390/children2020272.
  7. Dempsey E. M., Al Hazzani F., Barrington K. J. Permissive hypotension in the extremely low birthweight infant with signs of good perfusion // Archives of Disease in Childhood-Fetal and Neonatal Edition. 2009. Т. 94. № 4. P. 241–244. doi: 10.1136/adc.2007.124263.
  8. Miletin J., Pichova K., Dempsey E. M. Bedside detection of low systemic flow in the very low birth weight infant on day 1 of life // European journal of pediatrics. 2009. Т. 168. № 7. P. 809. doi: 10.1007/s00431-008-0840-9.
  9. Osborn D. A., Evans N., Kluckow M. Clinical detection of low upper body blood flow in very premature infants using blood pressure, capillary refill time, and central-peripheral temperature difference // Archives of Disease in ChildhoodFetal and Neonatal Edition. 2004. Т. 89. № 2. P. 168–173.
  10. Evans N. Volume expansion during neonatal intensive care: do we know what we are doing? // Seminars in neonatology. WB Saunders, 2003. Т. 8. № 4. P. 315–323. doi: 10.1016/S1084–2756 (03) 00021–6.
  11. Ewer A. K. Excessive volume expansion and neonatal death in preterm infants born at 27–28 weeks gestation // Paediatric and perinatal epidemiology. 2003. Т. 17. № 2. P. 180–186.
  12. Hope P. Pump up the volume? The routine early use of colloid in very preterm infants // Archives of Disease in ChildhoodFetal and Neonatal Edition. 1998. Т. 78. № 3. P. 163–165. doi: 10.1136/fn.78.3. F163.
  13. Dempsey E. M., Barrington K. J. Diagnostic criteria and therapeutic interventions for the hypotensive very low birth weight infant // Journal of perinatology. 2006. Т. 26. № 11. P. 677–681. doi: 10.1038/sj.jp.7211579.
  14. Dempsey E. M., Barrington K. J., Marlow N. et al. Management of hypotension in preterm infants (The HIP Trial): a randomised controlled trial of hypotension management in extremely low gestational age newborns // Neonatology. 2014. Т. 105. № 4. P. 275–281. doi: 10.1159/000357553.
  15. Evans N. Assessment and support of the preterm circulation // Early human development. 2006. Т. 82. № 12. P. 803–810. DOI: http://dx.doi.org/10.1016/j.earlhumdev.2006.09.020.
  16. Stranak Z., Semberova J., Barrington K. et al. HIP International survey on diagnosis and management of hypotension in extremely preterm babies // Europe Journal of Pediatrics. Jun 2014. Т. 173 (6). P. 793–798. DOI: 10.1007/ s00431-013-2251-9.
  17. Seri I. Systemic and pulmonary effects of vasopressors and inotropes in the neonate // Neonatology. 2006. Т. 89. № 4. P. 340–342. doi: 10.1159/000092872.
  18. Osborn D., Evans N., Kluckow M. Randomized trial of dobutamine versus dopamine in preterm infants with low systemic blood flow // The Journal of pediatrics. 2002. Т. 140. № 2. P. 183–191. doi: 10.1067/mpd.2002.120834.
  19. Huysman M. W., Hokken-koelega A. C., De Ridder M. A. et al. Adrenal function in sick very preterm infants // Pediatric Research. 2000. T. 48. № 5. P. 629–633. doi: 10.1203/00006450-200011000-00013.
  20. Pacifici G. M. Clinical pharmacology of dobutamine and dopamine in preterm neonates // MedicalExpress. 2014. Т. 1. № 5. P. 275–283. doi: 10.5935/MedicalExpress.2014.05.12.
  21. Filippi L., Cecchi A., Tronchin M., Dani et al. Dopamine infusion and hypothyroxinaemia in very low birth weight preterm infants // European journal of pediatrics. 2004. Т. 163. № 1. P. 7–13. doi: 10.1007/s00431-003-1359-8.
  22. Evans N. Which inotrope for which baby? // Archives of Disease in Childhood-Fetal and Neonatal Edition. 2006. Т. 91. № 3. P. 213–220. doi: 10.1136/adc.2005.071829.
  23. Clark S. J., Yoxall C. W., Subhedar N. V. Right ventricular performance in hypotensive preterm neonates treated with dopamine // Pediatric cardiology. 2002. Т. 23. № 2. P. 167–170. doi: 10.1007/s00246-001-0041-z.
  24. Lundstrøm K., Pryds O., Greisen G. The haemodynamic effects of dopamine and volume expansion in sick preterm infants // Early human development. 2000. Т. 57. № 2. P. 157–163.
  25. Ishiguro A., Suzuki K., Sekine T., Kawasaki H. et al. Effect of dopamine on peripheral perfusion in very-low-birth-weight infants during the transitional period // Pediatric research. 2012. Т. 72. № 1. P. 86–89. doi: 10.1038/pr.2012.37.
  26. Prins I., Plötz F. B., Uiterwaal C. S. et al. Low-dose dopamine in neonatal and pediatric intensive care: a systematic review // Intensive care medicine. 2001. Т. 27. № 1. P. 206–210.
  27. Paradisis M., Osborn D. A. Adrenaline for prevention of morbidity and mortality in preterm infants with cardiovascular compromise // Cochrane database systematic reviews. 2004. doi: 10.1002/14651858. CD003958
  28. El-Khuffash A. F., Jain A., Weisz D. et al. Assessment and treatment of post patent ductus arteriosus ligation syndrome // The Journal of pediatrics. 2014. Т. 165. № 1. P. 46–52. doi: 10.1016/j.jpeds.2014.03.048.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2017 Mitkinov O.E.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: ПИ № ФС 77 - 81892 от 24.09.2021 г.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies