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Preterm newborns with refractory hypotension
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| bet | 400/654 | | Sana | 03.01.2022 | | Hajmi | 1,5 Mb. | | #14803 |
Preterm newborns with refractory hypotension: Two case series report the effects of noradrenaline in preterm infants. Rowcliff et al reported noradrenaline [starting dose 0.4 (0.2–0.5) µg/kg/min maximum dose 0.7 (0.4–1.0) µg/kg/min] in 48 hypotensive infants born ≤32 weeks’ gestation with a primary diagnosis of sepsis (63 %) or pulmonary hypertension (23 %) refractory to other interventions. Normotension was achieved in all but one infant at a median dose of 0.5 µg/kg/min. The increased blood pressure did not lead to immediate improvement of pH, lactate or urine output. Tachycardia was common (31 %). Mortality was 46% and morbidity high.6 Rizk et al reported noradrenaline [starting dose 0.1 µg/kg/min); maximum dose 0.24 ± 0.15 µg/kg/min] in 30 hypotensive preterm infants with septic shock. Noradrenaline infusion was associated with improvements in blood pressure, urine output and FiO2, and reduction in other inotrope support. Mortality was 33.3%, 5 of 16 survivors assessed had cerebral palsy and developmental delay.7 [LOE IV, no recommendation].
Safety: In non-newborn patients, noradrenaline is associated with less arrhythmia compared to patients treated with dopamine. Overdose may result in severe hypertension, reflex bradycardia, marked increase in peripheral resistance and decreased cardiac output. Cohort studies show that delay in the use of inotropic therapies is associated with major increases in mortality risk. This delay is often related to difficulty in attaining central access. Inotropes can be given peripherally until central venous access can be attained in children who are not responsive to fluid resuscitation.1
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