Abstract
Objective:
We performed a multicenter study of preterm infants, who were about to undergo patent ductus arteriosus ligation, to determine whether echocardiographic indices of impaired myocardial performance were associated with subsequent development of catecholamine-resistant hypotension following ligation.
Study Design:
A standardized treatment approach for hypotension was followed at each center. Infants were considered to have catecholamine-resistant hypotension if their dopamine infusion was >15 μg kg–1min–1. Echocardiograms and cortisol measurements were obtained between 6 and 14 h after the ligation (prior to the presence of catecholamine-resistant hypotension).
Result:
Forty-five infants were enrolled, 10 received catecholamines (6 were catecholamine-responsive and 4 developed catecholamine-resistant hypotension). Catecholamine-resistant hypotension was not associated with decreased preload, shortening fraction or ventricular output. Infants with catecholamine-resistant hypotension had significantly lower levels of systemic vascular resistance and postoperative cortisol concentration.
Conclusion:
We speculate that low cortisol levels and impaired vascular tone may have a more important role than impaired cardiac performance in post-ligation catecholamine-resistant hypotension.
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Acknowledgements
This study was supported in part by grants from the Thrasher Research Fund, NIH/NCRR UCSF-CTSI grant numbers UL1 TR000004 and UL1 TR000445–06, NHLBI (HL109199) and a gift from the Jamie and Bobby Gates Foundation. Mass spectrometry was supported by grants for the Michigan Nutrition Obesity Center (DK089503) and Michigan Regional Comprehensive Metabolomics Research Core (U24DK097153).
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PDA Ligation/Hypotension Trial Investigators Study Coordinating Center: University of California San Francisco, San Francisco, CA, USA Ronald Clyman, MD. Andrea Wickremasinghe, MD. Michael Brook, MD. Neonatal Clinical Research Center nurses. Steroid Measurement Center: University of Michigan, Ann Arbor, MI, USA Richard Auchus, MD. Susan Matthews, PhD. Robert Chomic, MS. Stephen C Brown, PhD. Study sites: Loma Linda University, Loma Linda, CA, USA ( n =23) T Allen Merritt, MD, MHA. Tabitha Solomon, MD. Michael Kuhn, MD. Hospital for Sick Children, Toronto, ON, Canada ( n =16) Patrick McNamara, MD. Amish Jain, MD. Afif El-Khuffash MD. Jenny Luc, RRT. University of Oklahoma, Oklahoma City, OK, USA ( n =6) Shahab Noori, MD. Krishnamurthy Sekar, MD. Michael McCoy, MS, APRN. Karen Corff, MS, APRN. Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada ( n =6) Pascal Lavoie, MD, PhD. Jennifer Claydon, MSc. Nadine Lusney, RN. Kristi Finlay, RN. BC Children's Hospital Cardiology service. University of Virginia, Charlottesville, VA, USA ( n =5) Joshua T Attridge, MD. Amy E Blackman, RN. Jonathan R Swanson, MD. Pediatric Cardiac Sonographers. Vanderbilt University, Nashville, TN, USA ( n =4) Maria Gillam-Krakauer, MD. Jeff Reese, MD. Amy Law-Beller, RN. Indiana University, Indianapolis, IN, USA ( n =2) Brenda Poindexter, MD. Leslie Dawn Wilson, BSN, CCRC.
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Noori, S., McNamara, P., Jain, A. et al. Catecholamine-resistant hypotension and myocardial performance following patent ductus arteriosus ligation. J Perinatol 35, 123–127 (2015). https://doi.org/10.1038/jp.2014.151
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DOI: https://doi.org/10.1038/jp.2014.151
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