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Management of hypotension and low systemic blood flow in the very low birth weight neonate during the first postnatal week

Journal of Perinatology volume 26, pages S8–S13 (2006)Cite this article

Abstract

Systemic hypotension during the first postnatal week is associated with increased mortality and morbidity in the very low birth weight (VLBW) neonate. Hypotension is generally defined as blood pressure below the fifth percentile of the gestational- and postnatal-age dependent blood pressure norms. Recent studies indicate that in most VLBW neonates, cerebral blood flow autoregulation is indeed lost when blood pressure reaches the fifth percentile. Treatment of the circulatory compromise should address the primary pathogenic factor(s) of the condition (hypovolemia, myocardial compromise, failure of vasoregulation or a combination of factors). Recent findings also suggest that vasopressor resistance can be treated with a brief course of low-dose hydrocortisone. However, due to the short- and potential long-term side effects of early hydrocortisone treatment, its use should be restricted to neonates with vasopressor-resistant hypotension. Finally, concomitant administration of hydrocortisone with indomethacin should be avoided due to the increased incidence of gastrointestinal perforations.

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References

  1. Seri I . Circulatory support of the sick newborn infant. Semin Neonatol 2001; 6: 85–95.

    Article  CAS  PubMed  Google Scholar 

  2. Greisen G, Borch K . White matter injury in the preterm neonate: the role of perfusion. Dev Neurosci 2001; 23: 209–212.

    Article  CAS  PubMed  Google Scholar 

  3. Munro MJ, Walker AM, Barfield CP . Hypotensive extremely low birth weight infants have reduced cerebral blood flow. Pediatrics 2004; 114: 1591–1596.

    Article  PubMed  Google Scholar 

  4. Greisen G . Autoregulation of cerebral blood flow in newborn babies. Early Hum Dev 2005; 81: 423–428.

    Article  PubMed  Google Scholar 

  5. Tyszczuk L, Meek J, Elwell C, Wyatt JS . Cerebral blood flow is independent of mean arterial blood pressure in preterm infants undergoing intensive care. Pediatrics 1998; 102: 337–341.

    Article  CAS  PubMed  Google Scholar 

  6. Seri I, Abbasi S, Wood DC, Gerdes JS . Regional hemodynamic effects of dopamine in the sick preterm infant. J Pediatr 1998; 133: 728–734.

    Article  CAS  PubMed  Google Scholar 

  7. Kluckow M, Evans N . Superior vena flow in preterm infants: a novel marker of systemic blood flow. Arch Dis Child 2000; 82: F182.

    Article  CAS  Google Scholar 

  8. Kluckow M, Evans N . Low superior vena flow and intraventricular haemorrhage in preterm infants. Arch Dis Child 2000; 82: F188.

    Article  CAS  Google Scholar 

  9. Tsuji M, Saul PJ, du Plessis A, Eichenwald E, Sobh J, Crocker R et al. Cerebral intravascular oxygenation correlates with mean arterial pressure in critically ill premature infants. Pediatrics 2000; 106: 625–632.

    Article  CAS  PubMed  Google Scholar 

  10. Watkins AM, West CR, Cooke RW . Blood pressure and cerebral hemorrhage and ischemia in very low birth weight infants. Early Hum Dev 1989; 19: 103–110.

    Article  CAS  PubMed  Google Scholar 

  11. Bada HS, Korones SB, Perry EH, Arheart KL, Ray JD, Pourcyrous M et al. Mean arterial pressure changes in premature infants and those at risk for intraventricular hemorrhage. J Pediatr 1990; 117: 607–614.

    Article  CAS  PubMed  Google Scholar 

  12. Miall-Allen VM, de Vries LS, Whitelaw GL . Mean arterial blood pressure and neonatal cerebral lesions. Arch Dis Child 1987; 62: 1068–1069.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Lou HC, Skov J, Pedersen H . Low cerebral blood flow: a risk factor in the neonate. J Pediatr 1979; 95: 606–609.

    Article  CAS  PubMed  Google Scholar 

  14. Meek JH, Tyszczuk L, Elwell CE, Wyatt JS . Low cerebral blood flow is a risk factor for severe intraventricular hemorrhage. Arch Dis Child 1987; 62: 1068–1069.

    Article  Google Scholar 

  15. Volpe JJ . Neurologic outcome of prematurity. Arch Neurol 1998; 55: 297–300.

    Article  CAS  PubMed  Google Scholar 

  16. Goldstein RF, Thompson RJ, Oehler JM, Brazy JE . Influence of acidosis, hypoxemia, and hypotension on neurodevelopmental outcome in very low birth weight infants. Pediatrics 1995; 95: 238–243.

    CAS  PubMed  Google Scholar 

  17. Grether JK, Nelson KB, Emery III ES, Cummins SK . Prenatal and perinatal factors and cerebral palsy in very low birth weight infants. J Pediatr 1996; 128: 407–414.

    Article  CAS  PubMed  Google Scholar 

  18. Hunt RW, Evans N, Rieger I, Kluckow M . Low superior vena cava flow and neurodevelopment at 3 years in very preterm infants. J Pediatrics 2004; 145: 588–592.

    Article  Google Scholar 

  19. Noori S, Seri I . Pathophysiology of newborn hypotension outside the transitional period. Early Hum Dev 2005; 81: 399–404.

    Article  CAS  PubMed  Google Scholar 

  20. Seri I, Noori S . Diagnosis and treatment of newborn hypotension outside the transitional period. Early Hum Dev 2005; 81: 405–411.

    Article  PubMed  Google Scholar 

  21. Seri I . Cardiovascular, renal and endocrine actions of dopamine in neonates and children. J Pediatr 1995; 126: 333–344.

    Article  CAS  PubMed  Google Scholar 

  22. Pellicer A, Valverde E, Elorza MD, Madero R, Gaya F, Quero J et al. Cardiovascular support for low birth weight infants and cerebral hemodynamics: a randomized, blinded clinical trial. Pediatrics 2005; 115: 1501–1512.

    Article  PubMed  Google Scholar 

  23. Noori S, Friedlich P, Seri I . Pharmacology review: the use of dobutamine in the treatment of neonatal cardiovascular compromise. NeoReviews 2004; 5: 22–26.

    Article  Google Scholar 

  24. Roze JC, Tohier C, Maingureneau C, Lefevre M, Mouzard A . Response to dobutamine and dopamine in the hypotensive very preterm infant. Arch Dis Child 1993; 69: 59–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Evans N, Seri I . Cardiovascular compromise in the newborn infant In: Taeusch HW, Ballard RA, Gleason CA (eds). Avery's Diseases of the Newborn. WB Saunders Co: Philadelphia, 2004, pp 398–409.

    Google Scholar 

  26. Seri I . Hemodynamics during the first two postnatal days and neurodevelopment in preterm neonates. J Pediatr 2004; 145: 573–575.

    Article  PubMed  Google Scholar 

  27. Osborn D, Evans N, Kluckow M . Randomised trial of dopamine and dobutamine in preterm infants with low systemic blood flow. J Pediatr 2002; 140: 183–191.

    Article  CAS  PubMed  Google Scholar 

  28. Seri I, Rudas G, Bors ZS, Kanyicska B, Tulassay T . The effect of dopamine on renal function, cerebral blood flow and plasma catecholamine levels in sick preterm neonates. Pediatr Res 1993; 34: 742–749.

    Article  CAS  PubMed  Google Scholar 

  29. Yanowitz TD, Jordan JA, Gilmour CH, Towbin R, Bowen AD, Roberts JM et al. Hemodynamic disturbances in premature infants born after chorioamnionitis: association with cord blood cytokine concentrations. Pediatr Res 2002; 51: 310–316.

    Article  PubMed  Google Scholar 

  30. Ng PC, Lee HC, Lam CWK, Ma KC, Fok TF, Chan HIS et al. Transient adrenocortical insufficiency of prematurity and systemic hypotension in very low birth weight infants. Arch Dis Child Fetal Neonatal Ed 2004; 89: F119–F126.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Ng PC, Lam CWK, Fok TF, Lee HC, Ma KC, Chan HIS . Refractory hypotension in preterm infants with adrenocortical insufficiency. Arch Dis Child Fetal Neonatal Ed 2001; 84: F122–F124.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Helbock HJ, Insoft RM, Conte FA . Glucocorticoid-responsive hypotension in extremely low birth weight newborns. Pediatrics 1993; 92: 715–717.

    CAS  PubMed  Google Scholar 

  33. Seri I, Tan R, Evans J . The effect of hydrocortisone on blood pressure in preterm neonates with vasopressor-resistant hypotension. Pediatrics 2001; 107: 1070–1074.

    Article  CAS  PubMed  Google Scholar 

  34. Watterberg KL . Adrenal insufficiency and cardiac dysfunction in the preterm infant. Pediatr Res 2002; 51: 422–424.

    Article  CAS  PubMed  Google Scholar 

  35. Segar JL, Bedell K, Page WV . Effect of cortisol on gene expression of the renin-angiotensin system in fetal sheep. Pediatr Res 1995; 37: 641–646.

    Article  Google Scholar 

  36. Hadcock JR, Malbon CC . Regulation of beta-adrenergic receptors by ‘permissive’ hormones: glucocorticoids increase steady-state levels of receptor mRNA. Proc Natl Acad Sci USA 1988; 85: 8415–8419.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Knowles RG, Salter M, Brooks S, Moncada S . Glucocorticoids inhibit the expression of an inducible, but not the constitutive, nitric oxide synthase in vascular endothelial cells. Proc Natl Acad Sci USA 1990; 87: 10043–10047.

    Article  Google Scholar 

  38. Wehling M . Specific, nongenomic actions of steroid hormones. Annu Rev Physiol 1997; 59: 365–393.

    Article  CAS  PubMed  Google Scholar 

  39. Noori S, Friedlich P, Ebrahimi M, Wong P, Siassi B, Seri I . Hemodynamic Changes in Response to Hydrocortisone in Vasopressor-Treated Neonates (Abstract #581). Society of Pediatric Research: Washington, DC, 2005.

    Google Scholar 

  40. Watterberg KL, Gerdes JS, Cole CH, Aucott SW, Thilo EH, Mammel MC, Couser RJ, Garland JS, Rozycki HJ, Leach CL, Backstrom C, Shaffer ML . Prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia: a multicenter trial. Pediatrics 2004; 114: 1649–1657.

    Article  PubMed  Google Scholar 

  41. Lodygensky GA, Rademaker K, Zimine S, Gex-Fabry M, Lieftink AF, Lazeyras F et al. Structural and functional brain development after hydrocortisone treatment for neonatal lung disease. Pediatrics 2005; 116: 1–7.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. USC Division of Neonatal Medicine, Department of Pediatrics, Children Hospital Los Angeles, Los Angeles, CA, USA

    I Seri

  2. Women's and Children's Hospital, LAC/USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    I Seri

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Seri, I. Management of hypotension and low systemic blood flow in the very low birth weight neonate during the first postnatal week. J Perinatol 26 (Suppl 1), S8–S13 (2006). https://doi.org/10.1038/sj.jp.7211464

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