Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Catecholamine-resistant hypotension and myocardial performance following patent ductus arteriosus ligation

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.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Moin F, Kennedy KA, Moya FR . Risk factors predicting vasopressor use after patent ductus arteriosus ligation. Am J Perinatol 2003; 20: 313–320.

    Article  PubMed  Google Scholar 

  2. Harting MT, Blakely ML, Cox CS Jr, Lantin-Hermoso R, Andrassy RJ, Lally KP et al. Acute hemodynamic decompensation following patent ductus arteriosus ligation in premature infants. J Invest Surg 2008; 21: 133–138.

    Article  PubMed  Google Scholar 

  3. Teixeira LS, Shivananda SP, Stephens D, Van Arsdell G, McNamara PJ . Postoperative cardiorespiratory instability following ligation of the preterm ductus arteriosus is related to early need for intervention. J Perinatol 2008; 28: 803–810.

    Article  CAS  PubMed  Google Scholar 

  4. Clyman RI, Wickremasinghe A, Merritt TA, Solomon T, McNamara P, Jain A et al. Hypotension following patent ductus arteriosus ligation: The role of adrenal hormones. J Pediatr 2014; 164: 1449–1455.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Noori S, Friedlich P, Seri I, Wong P . Changes in myocardial function and hemodynamics after ligation of the ductus arteriosus in preterm infants. J Pediatr 2007; 150: 597–602.

    Article  PubMed  Google Scholar 

  6. McNamara PJ, Stewart L, Shivananda SP, Stephens D, Sehgal A . Patent ductus arteriosus ligation is associated with impaired left ventricular systolic performance in premature infants weighing less than 1000 g. J Thorac Cardiovasc Surg 2010; 140: 150–157.

    Article  PubMed  Google Scholar 

  7. Lemyre B, Liu L, Moore GP, Lawrence SL, Barrowman NJ . Do intra-operative fluids influence the need for postoperative cardiotropic support after a pda ligation? Zhongguo Dang Dai Er Ke Za Zhi 2011; 13: 1–7.

    PubMed  Google Scholar 

  8. Jain A, Sahni M, El-Khuffash A, Khadawardi E, Sehgal A, McNamara PJ et al. Use of targeted neonatal echocardiography to prevent postoperative cardiorespiratory instability after patent ductus arteriosus ligation. J Pediatr 2012; 160: 584–589 e581.

    Article  PubMed  Google Scholar 

  9. El-Khuffash A, McNamara PJ, Lapointe A, Jain A . Adrenal function in preterm infants undergoing patent ductus arteriosus ligation. Neonatology 2013; 104: 28–33.

    Article  CAS  PubMed  Google Scholar 

  10. Kimball TR, Ralston MA, Khoury P, Crump RG, Cho FS, Reuter JH et al. Effect of ligation of patent ductus arteriosus on left ventricular performance and its determinants in premature neonates. J Am Coll Cardiol 1996; 27: 193–197.

    Article  CAS  PubMed  Google Scholar 

  11. Takahashi Y, Harada K, Ishida A, Tamura M, Tanaka T, Takada G et al. Changes in left ventricular volume and systolic function before and after the closure of ductus arteriosus in full-term infants. Early Hum Dev 1996; 44: 77–85.

    Article  CAS  PubMed  Google Scholar 

  12. Lindner W, Seidel M, Versmold HJ, Dohlemann C, Riegel KP . Stroke volume and left ventricular output in preterm infants with patent ductus arteriosus. Pediatr Res 1990; 27: 278–281.

    Article  CAS  PubMed  Google Scholar 

  13. Zubrow AB, Hulman S, Kushner H, Falkner B . Determinants of blood pressure in infants admitted to neonatal intensive care units: A prospective multicenter study. Philadelphia neonatal blood pressure study group. J Perinatol 1995; 15: 470–479.

    CAS  PubMed  Google Scholar 

  14. Watkins AM, West CR, Cooke RW . Blood pressure and cerebral haemorrhage and ischaemia in very low birthweight infants. Early Hum Dev 1989; 19: 103–110.

    Article  CAS  PubMed  Google Scholar 

  15. Skippen PW, Krahn GE . Acute renal failure in children undergoing cardiopulmonary bypass. Crit Care Resusc 2005; 7: 286–291.

    CAS  PubMed  Google Scholar 

  16. Gaies MG, Gurney JG, Yen AH, Napoli ML, Gajarski RJ, Ohye RG et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010; 11: 234–238.

    Article  PubMed  Google Scholar 

  17. Rowland DG, Gutgesell HP . Use of mean arterial pressure for noninvasive determination of left ventricular end-systolic wall stress in infants and children. Am J Cardiol 1994; 74: 98–99.

    Article  CAS  PubMed  Google Scholar 

  18. Tei C, Nishimura RA, Seward JB, Tajik AJ . Noninvasive Doppler-derived myocardial performance index: correlation with simultaneous measurements of cardiac catheterization measurements. J Am Soc Echocardiogr 1997; 10: 169–178.

    Article  CAS  PubMed  Google Scholar 

  19. Gill AB, Weindling AM . Echocardiographic assessment of cardiac function in shocked very low birthweight infants. Arch Dis Child 1993; 68: 17–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Walther FJ, Siassi B, King J, Wu PY . Echocardiographic measurements in normal preterm and term neonates. Acta Paediatr Scand 1986; 75: 563–568.

    Article  CAS  PubMed  Google Scholar 

  21. Taylor LK, Auchus RJ, Baskin LS, Miller WL . Cortisol response to operative stress with anesthesia in healthy children. J Clin Endocrinol Metab 2013; 98 (9): 3687–3693.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Kulle AE, Welzel M, Holterhus PM, Riepe FG . Implementation of a liquid chromatography tandem mass spectrometry assay for eight adrenal c-21 steroids and pediatric reference data. Horm Res Paediatr 2013; 79: 22–31.

    Article  CAS  PubMed  Google Scholar 

  23. Noori S, Friedlich P, Wong P, Ebrahimi M, Siassi B, Seri I et al. Hemodynamic changes after low-dosage hydrocortisone administration in vasopressor-treated preterm and term neonates. Pediatrics 2006; 118: 1456–1466.

    Article  PubMed  Google Scholar 

  24. Seri I, Evans J . Controversies in the diagnosis and management of hypotension in the newborn infant. Curr Opin Pediatr 2001; 13: 116–123.

    Article  CAS  PubMed  Google Scholar 

  25. Ng PC, Lee CH, Lam CW, Ma KC, Fok TF, Chan IH et al. Transient adrenocortical insufficiency of prematurity and systemic hypotension in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 2004; 89: F119–F126.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

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).

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to R I Clyman.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2014.151

This article is cited by

Search

Quick links