Abstract
Introduction: neonatal units often use a combination of Dopamine and Dobutamine to treat hypotension in the preterm infant. Hydrocortisone is often used as a third or fourth line agent. Infants who are growth restricted and preterm often require multiple agents to combat hypotension.
Objective: to assess in which neonates Dopamine and/or Dobutamine were insufficient and characteristics of neonates where Hydrocortisone achieved a clinical response.
Methods: retrospective analysis of antenatal and postnatal factors in preterm infants requiring inotropic support in a UK tertiary neonatal unit.
Results: 41 preterm infants, mean gestational age 26 (range 23- 34)weeks, Out of 41 neonates, there were 10 sets of twins (3 MCDA) and 1 triplet, 2 had reduced end diastolic flow (EDF), 9/41 babies were affected by intrauterine growth restriction (IUGR). Using stepwise regression it was found that blood pressure was affected by reduced end diastolic flow antenatally or antepartum haemorrhage. 12/41 neonates needed >1 medication: 40% of these were IUGR. 14/41 needed repeat saline or blood boluses (4/14 were IUGR). 40/41 needed Dopamine. 9/41 needed Dobutamine and 10/41 Hydrocortisone. 5/10 infants requiring hydrocortisone were IUGR.
Conclusion: Intrauterine growth restriction is a significant risk factor for requiring multiple inotropic agents, these infants often do not respond adequately to Dopamine or Dobutamine alone. This is likely related to adrenal insufficiency following chronic hypoxia. Early judicious use of hydrocortisone in this group of infants may lead to earlier resolution of hypotension and its sequelae. Antenatal factors play an important role in response to inotropic agents.
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Issa, M., Job, S. & Curley, A. 350 Neonatal Inotropic Support: The Role of Antenatal Risk Factors. Pediatr Res 68 (Suppl 1), 181 (2010). https://doi.org/10.1203/00006450-201011001-00350
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DOI: https://doi.org/10.1203/00006450-201011001-00350