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dobutamine and shock in neonates

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
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
José M Cartaya, Luis E Rovira, Yamilet Segredo, Idalys Alvarez, Yoandra Acevedo, Ariel Moya
INTRODUCTION Sepsis is the most common direct cause of death worldwide and septic shock the syndrome's most serious complication. In 2002, the pediatric intensive care unit of the José Luis Miranda Pediatric University Hospital in Santa Clara (Villa Clara Province), Cuba, began implementing the recently published guidelines of the American College of Critical Care Medicine (ACCM) for management of pediatric and neonatal septic shock, observing a drop in case fatality from 34.6% to 19% between the years 2003 and 2007...
July 2014: MEDICC Review
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
Jean-Sébastien Pelletier, Joseph LaBossiere, Bryan Dicken, Richdeep S Gill, Consolato Sergi, Nasser Tahbaz, David Bigam, Po-Yin Cheung
Cardiovascular dysfunction in asphyxiated neonates contributes significantly to their morbidity and mortality. We have recently shown that a low-dose vasopressin infusion (0.005 - 0.01 units/kg per hour) may improve myocardial oxygen transport balance in a swine model of neonatal hypoxia-reoxygenation. We aimed to compare the systemic and regional hemodynamic effects of low-dose vasopressin to dobutamine, a synthetic beta-adrenoreceptor agonist. Piglets (1 - 5 days old, 1.6 - 2.2 kg) were anesthetized and instrumented to continuously monitor systemic hemodynamic parameters, including cardiac output and mesenteric flow indices...
October 2013: Shock
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
Chloë Joynt, David L Bigam, Gregory Charrois, Laurence D Jewell, Gregory Korbutt, Po-Yin Cheung
BACKGROUND: After resuscitation, asphyxiated neonates often develop poor cardiac function with hypotension, pulmonary hypertension and multiorgan ischemia. In a swine model of neonatal hypoxia-reoxygenation, effects of epinephrine, dobutamine and milrinone on systemic, pulmonary and regional hemodynamics and oxygen transport were compared. DESIGN: Controlled, block-randomized study. SETTING: University research laboratory. SUBJECT: Mixed breed piglets (1-3 days, 1...
June 2010: Intensive Care Medicine
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
Zakariya Al-Salam, Marwan Emara, Stephanie Wehlage, Sameh Abozaid, Scott T Johnson, David L Bigam, Po-Yin Cheung
Dobutamine, a beta-adrenoceptor agonist that is often used to treat myocardial dysfunction in asphyxiated neonates, may act on the adrenoceptors of platelets resulting in activation. Little information is available on the effect and mechanistic pathway of dobutamine on the platelet aggregatory function in neonatal asphyxia. Newborn piglets were acutely instrumented and exposed to hypoxia for 2 h and reoxygenation for 4 h. Piglets were randomized to receive dobutamine infusion (5, 10, or 20 microg/kg per min) or saline (hypoxic-control) at 2 to 4 h of reoxygenation (n = 8 each), and sham-operated animals were not exposed to hypoxia and reoxygenation (n = 6)...
September 2008: 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
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
Yong Y Han, Joseph A Carcillo, Michelle A Dragotta, Debra M Bills, R Scott Watson, Mark E Westerman, Richard A Orr
OBJECTIVE: Experimental and clinical studies of septic shock support the concept that early resuscitation with fluid and inotropic therapies improves survival in a time-dependent manner. The new American College of Critical Care Medicine-Pediatric Advanced Life Support (ACCM-PALS) Guidelines for hemodynamic support of newborns and children in septic shock recommend this therapeutic approach. The objective of this study was to determine whether early septic shock reversal and use of resuscitation practice consistent with the new ACCM-PALS Guidelines by community physicians is associated with improved outcome...
October 2003: Pediatrics
I Seri
In the majority of preterm infants, especially during the immediate postnatal period, hypotension is primarily caused by abnormal peripheral vasoregulation and/or myocardial dysfunction and not by absolute hypovolemia. Therefore, aggressive volume resuscitation is not warranted and is potentially harmful. Volume support should be limited to 10-20 ml/kg of isotonic saline administration and, if sustained normalization of the blood pressure cannot be achieved, early initiation of cardiovascular pharmacological support is recommended...
February 2001: Seminars in Neonatology: SN
I Casadevall, V Kazandjian, J F Germain, P Daoud, S Maherzi, L Desplanques, F Beaufils
BACKGROUND: Abdominal surgery in neonates may be complicated by acute renal failure that is sometimes due to increased intra-abdominal pressure. Correction of the decreased renal perfusion may be difficult. CASE REPORTS: Case no 1. A girl weighing 3,000 g was operated on at 3 hours of life for congenital omphalocele. Closing the defect induced increased intra-abdominal pressure and decreased systemic pressure. Despite dopamine, dobutamine, followed by furosemide, anuria persisted without manifestations of heart failure...
May 1993: Archives Françaises de Pédiatrie
M Mokhtari, E Gourrier, A el Hanache, C Wood
BACKGROUND: Neonatal shigellosis is rare and is usually encountered in unsanitary countries. It is occasionally responsible for manifestations of bacteremia such as septic shock and rash. CASE REPORT: A boy was born at 40 weeks of gestational age, while the end of labor was marked by temperature at 38 degrees C. His weight was 3,640 g and his height was 49.5 cm. The temperature of the newborn was 38 degrees C at 1 hour of life. He had hepatomegaly and X-rays showed abdominal distension...
June 1993: Archives Françaises de Pédiatrie
D J Driscoll
The determinants of cardiovascular function include preload, myocardial contractility, and afterload. Myocardial contractility and afterload can be altered pharmacologically and form the basis for the clinical management of shock with inotropic and chronotropic drugs. There are extensive data from experiments in laboratory animals that the immature cardiovascular system may respond differently to these inotropic and chronotropic agents than the mature cardiovascular system. Digitalis, isoproterenol, dopamine, and dobutamine are the most frequently used positive inotropic drugs in children...
December 1987: Clinics in Perinatology
V M Miall-Allen, A G Whitelaw
Mean arterial pressure (MAP) and heart rate (HR) were studied in 12 hypotensive preterm neonates given dopamine. A significant, although temporary, elevation in MAP (8 +/- 3 mm Hg; p less than .01) occurred in five neonates in response to 5 micrograms/kg.min, but an increase in MAP was found in all infants (11 +/- 6 mm Hg; p less than .01) when the infusion rate was doubled. This elevation was sustained only in five who previously showed some response to the slower infusion. HR was unaffected except for an increase of 22 +/- 12 beat/min (p less than ...
November 1989: Critical Care Medicine
V Bhatt-Mehta, M C Nahata
Dopamine hydrochloride is widely used to increase blood pressure, cardiac output, urine output, and peripheral perfusion in neonates, infants, and older children with shock and cardiac failure. Its pharmacologic effects are dose dependent, and at low, intermediate, and high dosages include dilation of renal, mesenteric, and cerebral vasculature; inotropic response in the myocardium; and increases in peripheral and renal vascular resistance, respectively. The inotropic response is diminished in neonates compared with older children and adults due to maturational differences in norepinephrine stores...
1989: Pharmacotherapy
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