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dopamine and shock in neonates

Chloe Joynt, Po-Yin Cheung
Preterm neonates often have hypotension which may be due to various etiologies. While it is controversial to define hypotension in preterm neonates, various vasoactive medications are commonly used to provide the cardiovascular support to improve the blood pressure, cardiac output, or to treat shock. However, the literature on the systemic and regional hemodynamic effects of these antihypotensive medications in neonates is deficient and incomplete, and cautious translation of findings from other clinical populations and animal studies is required...
2018: Frontiers in Pediatrics
Brian T Kalish
Hypotension is a common problem in neonates with complex underlying pathophysiology. Although treatment of low blood pressure is common, clinicians must use all available information to target neonates with compromised perfusion. Pharmacotherapy should be tailored to the specific physiologic perturbations of the individual neonate. Dopamine is the most commonly utilized agent and may be the most appropriate agent for septic shock with low diastolic blood pressure. However, alternative therapies should be considered for other etiologies of hypotension, including milrinone and vasopressin for persistent pulmonary hypertension of the newborn and dobutamine for patent ductus arteriosus...
January 1, 2017: Neonatal Network: NN
Patrizia Porcu, Valeria Lallai, Andrea Locci, Sandro Catzeddu, Valeria Serra, Maria Giuseppina Pisu, Mariangela Serra, Laura Dazzi, Alessandra Concas
BACKGROUND: Allopregnanolone plays a role in the stress response and homeostasis. Alterations in the estrogen milieu during the perinatal period influence brain development in a manner that persists into adulthood. Accordingly, we showed that a single administration of estradiol benzoate (EB) on the day of birth decreases brain allopregnanolone concentrations in adult female rats. OBJECTIVE: We examined whether the persistent decrease in allopregnanolone concentrations, induced by neonatal EB treatment, might affect sensitivity to stress during adulthood...
March 2017: Psychopharmacology
B Vishnu Bhat, Nishad Plakkal
Shock is characterized by inadequate oxygen delivery to the tissues, and is more frequent in very low birth weight infants, especially in the first few days of life. Shock is an independent predictor of mortality, and the survivors are at a higher risk of neurologic impairment. Understanding the pathophysiology helps to recognize and classify shock in the early compensated phase and initiate appropriate treatment. Hypovolemia is rarely the primary cause of shock in neonates. Myocardial dysfunction is especially common in extremely preterm infants, and in term infants with perinatal asphyxia...
October 2015: Indian Journal of Pediatrics
L Koch, A Bosk, M Sasse, P Ruef, J Poeschl
BACKGROUND: In 2002 and 2007, the American College of Critical Care Medicine (ACCCM) provided clinical guidelines for hemodynamic support of pediatric and neonatal patients in septic shock. In 2008 and 2013, the Surviving Sepsis Campaign (SSC) Guidelines Committee offered up-to-date clinical guidelines for the management of severe sepsis and septic shock in adults and in pediatric patients. The aim of this study was to assess the standard of care of neonates with severe sepsis and septic shock in German neonatal intensive care units (NICUs) with regard to variability in management and guideline conformity...
January 2015: Klinische Pädiatrie
Jarrett Linder, Emily Dawson, Paula Williams
Critical congenital heart disease (CCHD) is defined as a ductal-dependent congenital heart defect requiring surgical or percutaneous intervention via cardiac catheterization before 1 year of age. Most cases of CCHD can be diagnosed with prenatal ultrasound or fetal echocardiogram. If not prenatally diagnosed, CCHD can be stable in the newborn nursery due to persistent ductal patency, and the patient may only be diagnosed after ductal closure and development of cardiac symptoms at home. In this case, a 6-day-old female presented to the emergency department (ED) floppy with agonal respirations, poor capillary refill, and absent femoral pulses...
May 2014: Pediatric Annals
Shiv Sajan Saini, Praveen Kumar, Rohit Manoj Kumar
OBJECTIVE: We evaluated hemodynamic changes in preterm neonates with septic shock using functional echocardiography and studied the effects of vasoactive drugs on hemodynamic variables. DESIGN: Prospective observational study. SETTING: Level III neonatal ICU. SUBJECTS AND PATIENTS: We enrolled 52 preterm neonates with septic shock (shock group) and an equal number of gestation and postnatal age-matched healthy neonates (control group)...
June 2014: Pediatric Critical Care Medicine
Namdar Manouchehri, David L Bigam, Thomas Churchill, David Rayner, Chloe Joynt, Po-Yin Cheung
BACKGROUND: When asphyxiated neonates require additional cardiovascular support to moderate doses of dopamine infusion, controversy exists on the differential hemodynamic effects of two approaches (adding a second inotrope vs. increasing dopamine dosage). We hypothesized that high-dose dopamine (HD) would be detrimental to systemic and regional perfusion as compared with dopamine and epinephrine (D + E) combination therapy using a swine model of neonatal hypoxia-reoxygenation (H-R). METHODS: Twenty-seven piglets (1-4 d, 1...
April 2013: Pediatric Research
Shahab Noori, Istvan Seri
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...
March 2012: Clinics in Perinatology
Ruchi Rai, D K Singh
Dopamine and dobutamine have been widely used to treat shock with variable success in newborns. In this retrospective data analysis, we report on the use of adrenaline in 20 neonates with birth asphyxia and shock that was refractory to dopamine and dobutamine. We concluded that adrenaline is a safe and effective drug that can be used as an add-on therapy to dopamine and/or dobutamine in newborns with shock secondary to birth asphyxia.
September 2010: Indian Pediatrics
Ruchi Rai, D K Singh
Dopamine and dobutamine have been widely used to treat shock with variable success in newborns. In this retrospective data analysis, we report on the use of adrenaline in 20 neonates with birth asphyxia and shock that was refractory to dopamine and dobutamine. We concluded that adrenaline is a safe and effective drug that can be used as an add-on therapy to dopamine and/or dobutamine in newborns with shock secondary to birth asphyxia.
January 15, 2010: Indian Pediatrics
Ulf Mostad, Sigurd Fasting
BACKGROUND: Child physiology and disease is not the same as in adults, which implies different challenges within intensive care. The aim of this review article is to shed light on special diagnostic and therapeutic problems in paediatric intensive care. MATERIAL AND METHODS: The review is based on literature identified through a non-systematic search in PubMed, and on the authors' own clinical experience. RESULTS: Common causes for admitting children to intensive care units are head injuries; septic shock and respiratory failure...
January 14, 2010: Tidsskrift for Den Norske Lægeforening: Tidsskrift for Praktisk Medicin, Ny Række
Chris Schmaltz
While the methods of establishing and maintaining organ perfusion differ from one clinician to the next, the underlying physiological rationale remains constant. The gestalt for correcting circulatory compromise is generally performed in a stepwise manner; first ensuring that the vasculature is filled, then administering medications to tighten the vasculature, and lastly, compensating for an immature vasculature. This stepwise approach is reflected in the pharmacological interventions of providing fluid boluses (filling the pump), giving catecholamines (tightening the pump), and starting hydrocortisone (compensating for an immature pump)...
August 2009: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
L Kovacikova, K Dakkak, P Skrak, M Zahorec, M Holan
BACKGROUND: In neonates, left-sided obstructive heart defects are critical diseases requiring early recognition, initial stabilization, and transfer to Cardiac Center. OBJECTIVES: To assess management of these neonates in primary care hospitals. METHODS: Retrospective analysis of medical records of neonates admitted to Cardiac Intensive Care Unit in whom diagnosis of left-sided obstructive heart defect was established. RESULTS: During 8-year period records of 117 patients were evaluated...
2007: Bratislavské Lekárske Listy
Po-Yin Cheung, Sameh Abozaid, Zakariya Al-Salam, Scott Johnson, Yingqian Li, David Bigam
Shock and poor regional perfusion are common in asphyxiated neonates. We compared the systemic and regional hemodynamic effects of high-dose epinephrine (E) with those of dopamine combined with low-dose epinephrine (DE) infusions in a neonatal model of hypoxia-reoxygenation. Neonatal piglets (1-3 days, 1.5-2.5 kg) were acutely instrumented to continuously monitor systemic arterial pressure (SAP), pulmonary artery pressure, cardiac index (CI), and blood flows at the left common carotid, superior mesenteric, and renal arteries...
October 2007: Shock
Ghassan Chéhab, Zakhia Saliba, Philippe Chédid, Bernard Gerbaka, Chebl Mourani
OBJECTIVES: Diagnosis, initial workup and immediate prognosis in congenital or acquired heart diseases revealed by cardiogenic shock (CS) in a Lebanese paediatric multicentric study. MATERIAL AND METHODS: During a six-year period (1st January 1999 to 31 December 2004), 56 paediatric patients aged between 0 and 7 years have been admitted to the emergency departments or neonatal and intensive care units in ten different Lebanese hospitals, for high degree of CS suspicion with underlying cardiac disease...
October 2005: Le Journal Médical Libanais. the Lebanese Medical Journal
Valerie Boss, Augusto Sola, Tong-Chun Wen, Michael J Decker
We previously demonstrated that intermittent hypoxia evokes persistent changes in extracellular striatal dopamine, locomotor activity and executive function, using a rodent model emulating apnea of prematurity in which rat pups are exposed to 20-second bursts of hypoxic gas mix containing 10% oxygen (60 events/h; 6 h/day) from postnatal days 7 to 11. To determine whether subtle repetitive hypoxic insults also induce expression of stress-related genes, we employed real-time RT-PCR to assay gene transcription in neonatal rats subjected to the same paradigm...
2005: Biology of the Neonate
Istvan Seri, Shahab Noori
The etiology and pathophysiology of the circulatory compromise are among the primary determinants of the clinical presentation of patients with neonatal shock. Therefore, in the absence of direct assessment of cardiac output and organ blood flow, the characteristic clinical presentation itself may guide the initial management of the circulatory compromise. This chapter discusses different pathophysiology-driven management approaches to a number of characteristic clinical presentations of neonatal shock. The clinical presentations discussed in detail are the hypotensive very low birth weight neonate with a hemodynamically significant patent ductus arteriosus, and the preterm or term neonate with perinatal depression, pressor/inotrope resistance and relative adrenal insufficiency, and with specific systemic inflammatory response syndrome...
May 2005: Early Human Development
Nilto C De Oliveira, David A Ashburn, Faizah Khalid, Harold M Burkhart, Ian T Adatia, Helen M Holtby, William G Williams, Glen S Van Arsdell
BACKGROUND: After modifications in our perioperative management protocol, we have observed a decrease in sudden circulatory collapse after the Norwood operation. The current study examines early outcomes after the Norwood operation in our unit in an attempt to identify variables that may have altered the risk of unexpected circulatory collapse. METHODS AND RESULTS: We studied 105 consecutive neonates who underwent a Norwood operation in our institution. Our treatment protocol has changed in the past 3 years to include the use of alpha-blockade with phenoxybenzamine (POB) for systemic afterload reduction and selective cerebral perfusion...
September 14, 2004: Circulation
Ilan Matok, Leah Leibovitch, Amir Vardi, Miriam Adam, Marina Rubinshtein, Zohar Barzilay, Gideon Paret
OBJECTIVE: To report the successful use of terlipressin in an 8-day-old infant for treatment of intractable hypotension caused by septic shock. DESIGN: Descriptive case report. SETTING: An 18-bed pediatric intensive care unit at a tertiary care children's hospital. PATIENT: An 8-day-old child with intractable hypotension due to septic shock after heart surgery. INTERVENTIONS: General supportive intensive care including mechanical ventilatory support, volume replacement, and inotropic support with dopamine 20 microg...
March 2004: Pediatric Critical Care Medicine
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