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Adrenaline therapy in neonates

Eugenio Baraldi, Marcello Lanari, Paolo Manzoni, Giovanni A Rossi, Silvia Vandini, Alessandro Rimini, Costantino Romagnoli, Pierluigi Colonna, Andrea Biondi, Paolo Biban, Giampietro Chiamenti, Roberto Bernardini, Marina Picca, Marco Cappa, Giuseppe Magazzù, Carlo Catassi, Antonio Francesco Urbino, Luigi Memo, Gianpaolo Donzelli, Carlo Minetti, Francesco Paravati, Giuseppe Di Mauro, Filippo Festini, Susanna Esposito, Giovanni Corsello
Acute bronchiolitis is the leading cause of lower respiratory tract infection and hospitalization in children less than 1 year of age worldwide. It is usually a mild disease, but some children may develop severe symptoms, requiring hospital admission and ventilatory support in the ICU. Infants with pre-existing risk factors (prematurity, bronchopulmonary dysplasia, congenital heart diseases and immunodeficiency) may be predisposed to a severe form of the disease. Clinical diagnosis of bronchiolitis is manly based on medical history and physical examination (rhinorrhea, cough, crackles, wheezing and signs of respiratory distress)...
2014: Italian Journal of Pediatrics
Irene Moraa, Nancy Sturman, Treasure McGuire, Mieke L van Driel
BACKGROUND: Croup is thought to be triggered by a viral infection and is characterised by respiratory distress due to upper airway inflammation and swelling of the subglottic mucosa in children. Mostly it is mild and transient and resolves with supportive care. In moderate to severe cases, treatment with corticosteroids and nebulised epinephrine (adrenaline) is required. Corticosteroids improve symptoms but it takes time for a full effect to be achieved. In the interim, the child is at risk of further deterioration...
2013: Cochrane Database of Systematic Reviews
Liviana Da Dalt, Silvia Bressan, Francesco Martinolli, Giorgio Perilongo, Eugenio Baraldi
Bronchiolitis is a leading cause of acute illness and hospitalization for infants and young children worldwide. It is usually a mild disease, but the few children developing severe symptoms need to be hospitalized and some will need ventilatory support. To date, the mainstay of therapy has been supportive care, i.e. assisted feeding and hydration, minimal handling, nasal suctioning and oxygen therapy. In recent years the delivery of oxygen has been improved by using a high-flow nasal cannula. At the same time, the discovery of nebulized hypertonic saline enables better airway cleaning with a benefit for respiratory function...
June 2013: Early Human Development
P D Colding, L M Kolstrup, J A Hyldebrandt, M R Schmidt, H E Bøtker, H B Ravn
INTRODUCTION: Neonates undergoing congenital heart surgery frequently need post-operative inotropic support. Knowledge about the effect of inotropes on myocardial metabolism in the newborn heart is limited, and the choice of inotropic therapy is based mainly on evidence from studies in adults. The aim of this study was to compare the effect of three inotropic strategies on the myocardial metabolism in a neonatal pig model. METHODS: Newborn piglets were randomised to intravenous infusions with: adrenaline and milrinone; dopamine and milrinone; dobutamine in haemodynamically equivalent doses; or isotonic saline, through 3 h...
April 2013: Acta Anaesthesiologica Scandinavica
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
Silvija Hunyadi-Anticević, Ingrid Bosan-Kilibarda, Zeljko Colak, Boris Filipović-Grcić, Ivan Gornik, Ines Lojna-Funtak, Zdravka Poljaković, Aleksandar Schnapp, Branka Tomljanović
ADULT BASIC LIFE SUPPORT: The ratio of compressions to ventilations is 30:2 for all adult victims of cardiac arrest. AUTOMATED EXTERNAL DEFIBRILLATION: A single defibrillatory shock is delivered, immediately followed by two minutes of uninterrupted CPR. ADULT ADVANCED LIFE SUPPORT: In out-of-hospital cardiac arrest attended, but unwitnessed, by healthcare professionals equipped with manual defibrillators, give CPR for 2 minutes before defibrillation. The recommended initial energy for biphasic defibrillators is 150-200 J, for second and subsequent shocks is 150-360 J...
January 2006: Lijec̆nic̆ki Vjesnik
Jonathan M Fanaroff, Avroy A Fanaroff
Although many sick newborns are treated for hypotension and hypertension, the normal physiologic blood pressure range ensuring appropriate organ perfusion is uncertain. Treatment decisions are based on statistically defined gestational and postnatal age-dependent normative blood-pressure values, combined with clinical intuition, because of difficulties evaluating organ perfusion and adequacy of cerebral oxygen delivery. Early-onset hypotension usually results from the combined effects of abnormal peripheral vasoregulation, myocardial dysfunction, and hypovolemia...
June 2006: Seminars in Fetal & Neonatal Medicine
M F Almeida, R Guinsburg
OBJECTIVE: To describe the main controversies surrounding newborn resuscitation procedures. SOURCES: Systematic review of articles from MEDLINE, LILACS and Cochrane Library, and of abstracts published in Pediatric Research, using the keywords resuscitation, asphyxia neonatorum, and newborn infant. SUMMARY OF THE FINDINGS: The effectiveness of hypothermia and ambient air ventilation has been under study. The reduction of barotrauma and volutrauma in the ventilation of preterm infants is still a challenge. The indication of endotracheal intubation in preterm infants based only on their extremely low weight is not a general agreement, except if the use of exogenous surfactant is required...
July 2001: Jornal de Pediatria
I Germanakis, C Bender, R Hentschel, K Braun, S Dittrich, D Kececioglu
UNLABELLED: Catecholamine treatment for hypotension is common practice in neonatal intensive care units. In the presence of left ventricular hypertrophy, the positive inotropic action of catecholamines with mainly beta-receptor specificity can lead to excessive hypercontractility and paradoxical hypotension. This reports presents two cases of hypercontractile heart failure during beta-agonist treatment in very low birthweight (VLBW) infants. Both patients (27 wk, 5 d; and 26 wk, 6 d of gestation) underwent surgical arterial duct ligation and coarctation repair...
July 2003: Acta Paediatrica
S L Cheung, P D Booker, R Franks, M Pozzi
We have studied the efficacy of prolonged, continuous paravertebral infusion of bupivacaine for the management of post-thoracotomy pain in 22 infants with a median age of 1.5 weeks (range 1 day to 20.4 weeks). Immediately before chest closure, 0.25% bupivacaine 1.25 mg kg-1 was given into an extrapleural paravertebral catheter, inserted under direct vision. Subsequently, 0.125% bupivacaine with adrenaline 1:400000 was infused at a rate of 0.2 ml kg-1 h-1 for 48 h. We confirmed that extrapleural paravertebral catheter placement under direct vision was easy in neonates and infants...
July 1997: British Journal of Anaesthesia
K Frenzel, G Burda, G Fürst, J Golej, M Hermon, G Trittenwein, A Pollak
Adrenalin insufficiency associated with adrenal hemorrhage, is a rare complication after cardiac surgery in neonates. A boy suffering from transposition of the great arteries, who had an arterial switch-operation on day three of his life, acquired a bilateral adrenal hemorrhage. Clinically the situation resembled a septic shock. Despite large doses of catecholamines, he continued to have severe arterial hypotension, anuria, and kyperkalemia. The clinical condition did not change, although sepsis specific therapy was initiated...
January 1997: Klinische Pädiatrie
C Steinberg, D A Notterman
Infants and children with congenital or acquired heart disease and children with systemic disease often require pharmacological support of their failing circulation. Catecholamines may serve as inotropic (enhance myocardial contractility) or vasopressor (elevate systemic vascular resistance) agents. Noncatecholamine inotropic agents, such as the cardiac glycosides or the bipyridines, may be used in place of, or in addition to, catecholamines. Developmental changes in neonates, infants and children will affect the response to inotropic or pressor therapy...
November 1994: Clinical Pharmacokinetics
B Zickmann, J Boldt, C Knothe, J Bauer, F Dapper, G Hempelmann
Paediatric cardiac transplantation (pHTX) has gained widespread acceptance as a therapy in end-stage myocardial failure and some forms of congenital heart disease, particularly hypoplastic left heart syndrome (HLHS). The major problems to the anaesthesiologist in these patients are induction of anaesthesia in infants with HLHS and treatment of pulmonary hypertension in the early post-bypass period. PATIENTS AND METHODS. Anaesthesia for pHTX was performed in 15 children < 1 year of age (4-237 days); 12 suffered from HLHS, 2 from endocardial fibroelastosis, and 1 from dilatative cardiomyopathy...
April 1995: Der Anaesthesist
G T Tucker, L E Mather
The introduction of the new long acting local anaesthetics, bupivacaine and etidocaine, has stimulated an expansion of interest in regional anaesthesia, particularly for obstetrical applications and pain therapy. System toxicity following injection of local anesthetics occurs albeit infrequently, and tentative correlations have been made between the onset of CNS and cardiovascular effects and circulating drug concentrations in both adults and neonates. Amongst other factors, interpretation of these relationships depends upon blood distribution and plasma binding of the agents, sampling sites and acid-base balance...
July 1979: Clinical Pharmacokinetics
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