Treatment of neonatal hemodynamic compromise
Authors:
J. Širc; Z. Straňák
Authors‘ workplace:
3. lékařská fakulta Univerzity Karlovy, Praha
; Ústav pro péči o matku a dítě, Praha
Published in:
Čes-slov Neonat 2022; 28 (1): 28-34.
Category:
Reviews
Overview
Acute circulatory failure (ACF) is a serious and life-threatening complication in a newborn. ACF can occur throughout the whole neonatal life. Diagnosis of ACF is complicated by the size of patients, limited invasive methods and presence of intra and extracardiac shunts. The spectrum of drugs affecting the circulatory system is relatively broad. However, explored effects are often based on experimental studies or studies in adults. Thus, it is difficult to extrapolate these conclusions to neonates. Moreover, each drug affects the circulation at a different level and in a different way. The optimal therapy must therefore be tailored and the effect on hemodynamics must be monitored accordingly. Recently published data revealed that we can sufficiently influence some parameters of the circulatory system in circulatory compromised newborns, but without a positive effect on long-term neurological outcome.
Keywords:
corticosteroids – Catecholamines – Hypotension – Vasopressin – Norepinephrine – epinephrine – haemodynamic support – dopamin – dobutamin – milrinone – sildenafil – levosimendan
Sources
1. Barrington K, El-Khuffash A, Dempsey E. Intervention and outcome for neonatal hypotension. Clin Perinatol 2020; 47(3): 563–574. doi: 10.1016/j.clp.2020.05.011. Epub 2020 May 20. PMID: 32713451.
2. Batton B, Li L, Newman NS, Das A, Watterberg KL, Yoder BA, Faix RG, Laughon MM, Stoll BJ, Higgins RD, Walsh MC; Eunice Kennedy Shriver National Institute of Child Health & Human Development Neonatal Research Network. Early blood pressure, antihypotensive therapy and outcomes at 18– 22 months‘ corrected age in extremely preterm infants. Arch Dis Child Fetal Neonatal Ed 2016; 101(3): F201–206. doi: 10.1136/ archdischild-2015-308899. Epub 2015 Nov 13. PMID: 26567120; PMCID: PMC4849123.
3. Batton B, Li L, Newman N, et al. Evolving blood pressure dynamics for extremely preterm infants. J Perinatol 2014; 34: 301–305.
4. Bell EF, Acarregui MJ. Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2014; 2014(12): CD000503. doi: 10.1002/14651858.CD000503.pub3. Epub 2014 Dec 4. PMID: 25473815; PMCID: PMC7038715.
5. Corrall RJ, Frier BM, Davidson NM, French EB. Hormonal and substrate responses during recovery from hypoglycaemia in man during beta 1-selective and non-selective beta-adrenergic blockade. Eur J Clin Invest 1981; 11(4): 279–83. doi: 10.1111/j.1365- 2362.1981.tb02117.x. PMID: 6795044.
6. Dempsey E, Rabe H. The use of cardiotonic drugs in neonates. Clin Perinatol 2019; 46(2): 273–290. doi: 10.1016/j.clp.2019.02.010. Epub 2019 Mar 30. PMID: 31010560.
7. Report of a Joint Working Group of the British Association of Perinatal Medicine and the Research Unit of the Royal College of Physicians. Development of audit measures and guidelines for good practice in the management of neonatal respiratory distress syndrome. Arch Dis Child 1992; 67(10 Spec No): 1221–1227. doi: 10.1136/adc.67.10_spec_no.1221. PMID: 1444567; PMCID: PMC1590463.
8. Diprose GK, Evans DH, Archer LN, Levene MI. Dinamap fails to detect hypotension in very low birthweight infants. Arch Dis Child 1986; 61(8): 771–773.
9. Farrugia R, Rojas H, Rabe H. Diagnosis and management of hypotension in neonates. Future Cardiol 2013; 9(5): 669–79. doi: 10.2217/fca.13.59. PMID: 24020669.
10. Faust K, Härtel C, Preuß M, Rabe H, Roll C, Emeis M, Wieg C, Szabo M, Herting E, Göpel W; Neocirculation project and the German Neonatal Network (GNN). Short-term outcome of verylow- birthweight infants with arterial hypotension in the first 24 h of life. Arch Dis Child Fetal Neonatal Ed 2015; 100(5): F388–392. doi: 10.1136/archdischild-2014-306483. Epub 2015 Jul 21. PMID: 26199082.
11. Filippi L, Gozzini E, Daniotti M, Pagliai F, Catarzi S, Fiorini P. Rescue treatment with terlipressin in different scenarios of refractory hypotension in newborns and infants. Pediatr Crit Care Med 2011; 12(6): e237–241. doi: 10.1097/PCC.0b013e3181fe304c. PMID: 21057354.
12. Filippi L, Pezzati M, Poggi C, Rossi S, Cecchi A, Santoro C. Dopamine versus dobutamine in very low birthweight infants: Endocrine effects. Arch Dis Child Fetal Neonatal Ed 2007; 92(5): F367–371. doi: 10.1136/adc.2006.098566. Epub 2007 Feb 28. PMID: 17329276; PMCID: PMC2675359.
13. Giesinger RE, McNamara PJ. Hemodynamic instability in the critically ill neonate: An approach to cardiovascular support based on disease pathophysiology. Semin Perinatol 2016; 40(3): 174–188. doi: 10.1053/j.semperi.2015.12.005. Epub 2016 Jan
14. PMID: 26778235. 14. Groves AM, Kuschel CA, Knight DB, Skinner JR. Relationship between blood pressure and blood flow in newborn preterm infants. Arch Dis Child Fetal Neonatal Ed 2008;93(1): F29–F32.
15. Hallik M, Ilmoja ML, Tasa T, Standing JF, Takkis K, Veigure R, Kipper K, Jalas T, Raidmäe M, Uibo K, Starkopf J, Metsvaht T. Population pharmacokinetics and dosing of milrinone after patent ductus arteriosus ligation in preterm infants. Pediatr Crit Care Med 2019; 20(7): 621–629. doi: 10.1097/PCC.0000000000001879. PMID: 30664589.
16. Hansen ML, Pellicer A, Gluud C, Dempsey E, Mintzer J, Hyttel- Sørensen S, Heuchan AM, Hagmann C, Ergenekon E, Dimitriou G, Pichler G, Naulaers G, Cheng G, Guimarães H, Tkaczyk J, Kreutzer KB, Fumagalli M, Claris O, Lemmers P, Fredly S, Szczapa T, Austin T, Jakobsen JC, Greisen G. Cerebral near-infrared spectroscopy monitoring versus treatment as usual for extremely preterm infants: A protocol for the SafeBoosC randomised clinical phase III trial. Trials 2019; 20(1): 811. doi: 10.1186/ s13063-019-3955-6. PMID: 31888764; PMCID: PMC6937938.
17. Hansmann G, Sallmon H, Roehr CC, Kourembanas S, Austin ED, Koestenberger M; European Pediatric Pulmonary Vascular Disease Network (EPPVDN). Pulmonary hypertension in bronchopulmonary dysplasia. Pediatr Res 2021; 89(3): 446–455. doi: 10.1038/s41390-020-0993-4. Epub 2020 Jun 10. PMID: 32521539; PMCID: PMC7979539.
18. https://derangedphysiology.com/cicm-primary-exam/required- reading/cardiovascular-system
19. Huang L, Zhang S, Chang W, Xia F, Liu S, Yang Y, Qiu H. Terlipressin for the treatment of septic shock in adults: A systematic review and meta-analysis. BMC Anesthesiol 2020; 20(1): 58. doi: 10.1186/s12871-020-00965-4. PMID: 32138657; PMCID: PMC7057452.
20. Hyttel-Sorensen S, Pellicer A, Alderliesten T, Austin T, van Bel F, Benders M, Claris O, Dempsey E, Franz AR, Fumagalli M, Gluud C, Grevstad B, Hagmann C, Lemmers P, van Oeveren W, Pichler G, Plomgaard AM, Riera J, Sanchez L, Winkel P, Wolf M, Greisen G. Cerebral near infrared spectroscopy oximetry in extremely preterm infants: Phase II randomised clinical trial. BMJ 2015; 350: g7635. doi: 10.1136/bmj.g7635. PMID: 25569128; PMCID: PMC4283997.
21. Cheng L, Yan J, Han S, Chen Q, Chen M, Jiang H, Lu J. Comparative efficacy of vasoactive medications in patients with septic shock: a network meta-analysis of randomized controlled trials. Crit Care 2019; 23(1): 168. doi: 10.1186/s13054-019-2427-4. PMID: 31088524; PMCID: PMC6518735.
22. James AT, Corcoran JD, McNamara PJ, Franklin O, El-Khuffash AF. The effect of milrinone on right and left ventricular function when used as a rescue therapy for term infants with pulmonary hypertension. Cardiol Young 2016; 26(1): 90–99. doi: 10.1017/ S1047951114002698. Epub 2015 Jan 20. PMID: 25599873.
23. Jiang L, Sheng Y, Feng X, Wu J. The effects and safety of vasopressin receptor agonists in patients with septic shock: a meta- analysis and trial sequential analysis. Crit Care 2019; 23(1): 91. doi: 10.1186/s13054-019-2362-4. PMID: 30871607; PMCID: PMC6419432.
24. Jothinath K, Balakrishnan S, Raju V, Menon S, Osborn J. Clinical efficacy of levosimendan vs milrinone in preventing low cardiac output syndrome following pediatric cardiac surgery. Ann Card Anaesth 2021; 24(2): 217–223. doi: 10.4103/aca.ACA_160_19. PMID: 33884979; PMCID: PMC8253017.
25. Kelly LE, Ohlsson A, Shah PS. Sildenafil for pulmonary hypertension in neonates. Cochrane Database Syst Rev 2017; 8(8): CD005494. doi: 10.1002/14651858.CD005494.pub4. PMID: 28777888; PMCID: PMC6483280.
26. Kent A, Kecskes A, Shadbolt B, Falk M. Normative blood pressure data in the early neonatal period. Pediatr Nephrol 2007; 22: 1335–1341.
27. Kent A, Meskell S, Falk M, Shadbolt B. Normative blood pressure data in non-ventilated premature neonates from 28–36 weeks gestation. Pediatr Nephrol 2009; 24: 141–146.
28. Kuint J, Barak M, Morag I, Maayan-Metzger A. Early treated hypotension and outcome in very low birth weight infants. Neonatology 2009; 95(4): 311–6. doi: 10.1159/000180113. Epub 2008 Dec 4. PMID: 19052477.
29. Lakshminrusimha S, Mathew B, Leach CL. Pharmacologic strategies in neonatal pulmonary hypertension other than nitric oxide. Semin Perinatol 2016; 40(3): 160–73. doi: 10.1053/j.semperi. 2015.12.004. Epub 2016 Jan 14. PMID: 26778236; PMCID: PMC4808469.
30. Liet JM, Boscher C, Gras-Leguen C, Gournay V, Debillon T, Rozé JC. Dopamine effects on pulmonary artery pressure in hypotensive preterm infants with patent ductus arteriosus. J Pediatr 2002; 140(3): 373–375. doi: 10.1067/mpd.2002.123100. PMID: 11953739.
31. Masarwa R, Paret G, Perlman A, Reif S, Raccah BH, Matok I. Role of vasopressin and terlipressin in refractory shock compared to conventional therapy in the neonatal and pediatric population: a systematic review, meta-analysis, and trial sequential analysis. Crit Care 2017; 21(1): 1. doi: 10.1186/s13054-016-1589-6. PMID: 28057037; PMCID: PMC5217634.
32. McNamara PJ, Shivananda SP, Sahni M, Freeman D, Taddio A. Pharmacology of milrinone in neonates with persistent pulmonary hypertension of the newborn and suboptimal response to inhaled nitric oxide. Pediatr Crit Care Med 2013; 14(1): 74–84. doi: 10.1097/PCC.0b013e31824ea2cd. PMID: 23132395.
33. Meyer S, Sander J, Gräber S, Gottschling S, Gortner L. Agreement of invasive versus non-invasive blood pressure in preterm neonates is not dependent on birth weight or gestational age. J Paediatr Child Health 2010; 46(5): 249–254.
34. Miall-Allen VM, de Vries LS, Whitelaw AG. Mean arterial blood pressure and neonatal cerebral lesions. Arch Dis Child 1987; 62(10): 1068–1069. doi: 10.1136/adc.62.10.1068. PMID: 3314723; PMCID: PMC1778679.
35. Ortega-Loubon C, Herrera-Gómez F, Bernuy-Guevara C, Jorge-Monjas P, Ochoa-Sangrador C, Bustamante-Munguira J, Tamayo E, Álvarez FJ. Near-infrared spectroscopy monitoring in cardiac and non-cardiac surgery: Pairwise and network meta-analyses. J Clin Med 2019; 8(12): 2208. doi: 10.3390/jcm8122208. PMID: 31847312; PMCID: PMC6947303.
36. Osborn DA, Evans N. Early volume expansion for prevention of morbidity and mortality in very preterm infants. Cochrane Database Syst Rev 2004; 2004(2): CD002055. doi: 10.1002/14651858.CD002055.pub2. PMID: 15106166; PMCID: PMC7025803.
37. Osborn D, Evans N, Kluckow M. Randomized trial of dobutamine versus dopamine in preterm infants with low systemic blood flow. J Pediatr 2002; 140(2): 183–191. doi: 10.1067/mpd.2002.120834. PMID: 11865269.
38. Oulego-Erroz I, Terroba-Seara S, Castanon-Lopez L, Rodriguez-Nunez A. Rescue treatment with terlipressin for persistent pulmonary hypertension and refractory shock in a preterm infant. Indian Pediatr 2020; 57(9): 864–865. doi: 10.1007/s13312- 020-1972-x. PMID: 32999121; PMCID: PMC7498553.
39. Paradisis M, Evans N, Kluckow M, Osborn D. Randomized trial of milrinone versus placebo for prevention of low systemic blood flow in very preterm infants. J Pediatr 2009; 154(2): 189–95. doi: 10.1016/j.jpeds.2008.07.059. Epub 2008 Sep 25. PMID: 18822428.
40. Paradisis M, Jiang X, McLachlan AJ, Evans N, Kluckow M, Osborn D. Population pharmacokinetics and dosing regimen design of milrinone in preterm infants. Arch Dis Child Fetal Neonatal Ed 2007; 92(3): F204–209. doi: 10.1136/adc.2005.092817. Epub 2006 May 11. PMID: 16690639; PMCID: PMC2675339.
41. Pellicer A, Valverde E, Elorza MD, Madero R, Gayá F, Quero J, Cabañas F. Cardiovascular support for low birth weight infants and cerebral hemodynamics: a randomized, blinded, clinical trial. Pediatrics 2005; 115(6): 1501–1512. doi: 10.1542/peds.2004-1396. PMID: 15930210.
42. Perez M, Lakshminrusimha S, Wedgwood S, Czech L, Gugino SF, Russell JA, Farrow KN, Steinhorn RH. Hydrocortisone normalizes oxygenation and cGMP regulation in lambs with persistent pulmonary hypertension of the newborn. Am J Physiol Lung Cell Mol Physiol 2012; 302(6): L595–603. doi: 10.1152/ ajplung.00145.2011. Epub 2011 Dec 23. PMID: 22198909; PMCID: PMC3311533.
43. Seri I, Rudas G, Bors Z, Kanyicska B, Tulassay T. Effects of low-dose dopamine infusion on cardiovascular and renal functions, cerebral blood flow, and plasma catecholamine levels in sick preterm neonates. Pediatr Res 1993; 34(6): 742–749. doi: 10.1203/00006450-199312000-00009. PMID: 8108186.
44. Seri I, Tan R, Evans J. Cardiovascular effects of hydrocortisone in preterm infants with pressor-resistant hypotension. Pediatrics 2001; 107(5): 1070–1074. doi: 10.1542/peds.107.5.1070. PMID: 11331688.
45. Siefkes HM, Lakshminrusimha S. Management of systemic hypotension in term infants with persistent pulmonary hypertension of the newborn: an illustrated review. Arch Dis Child Fetal Neonatal Ed 2021; 106(4): 446–455. doi: 10.1136/archdischild- 2020-319705. Epub 2021 Jan 21. PMID: 33478959; PMCID: PMC8217132.
46. Silvetti S, Silvani P, Azzolini ML, Dossi R, Landoni G, Zangrillo A. A systematic review on levosimendan in paediatric patients. Curr Vasc Pharmacol 2015; 13(1): 128–133. doi: 10.2174/157016 1112666141127163536. PMID: 25440597.
47. Stathopoulos L, Nicaise C, Michel F, Thomachot L, Merrot T, Lagier P, Martin C. Terlipressin as rescue therapy for refractory pulmonary hypertension in a neonate with a congenital diaphragmatic hernia. J Pediatr Surg 2011; 46(2): e19–21. doi: 10.1016/j. jpedsurg.2010.10.006. PMID: 21292065.
48. Stranak Z, Semberova J, Barrington K, O‘Donnell C, Marlow N, Naulaers G, Dempsey E; HIP consortium. International survey on diagnosis and management of hypotension in extremely preterm babies. Eur J Pediatr 2014; 173(6): 793–798. doi: 10.1007/ s00431-013-2251-9. Epub 2014 Jan 4. PMID: 24390060; PMCID: PMC4032643.
49. Taketomo CK, Hodding JH, Kraus DM. Pediatric and neonatal handbook: A universal resource for clinicians treating pediatric and neonatal patients, 23rd Ed. Lexi-Comp Inc 2016.
50. Thorlacius EM, Wåhlander H, Ojala T, Ylänen K, Keski-Nisula J, Synnergren M, Romlin BS, Ricksten SE, Castellheim A. Levosimendan vs. milrinone for inotropic support in pediatric cardiac surgery: Results from a randomized trial. J Cardiothorac Vasc Anesth 2020; 34(8): 2072–2080. doi: 10.1053/j.jvca.2020.02.027. Epub 2020 Feb 24. PMID: 32201198.
51. Vesoulis Z, El Ters N, Wallendorf M, Mathur A. Empirical estimation of the normative blood pressure in infants < 28 weeks gestation using a massive data approach. J Perinatol 2016; 36: 291–295
52. Wang A, Cui C, Fan Y, Zi J, Zhang J, Wang G, Wang F, Wang J, Tan Q. Prophylactic use of levosimendan in pediatric patients undergoing cardiac surgery: A prospective randomized controlled trial. Crit Care 2019; 23(1): 428. doi: 10.1186/s13054-019-2704-2. PMID: 31888711; PMCID: PMC6937718.
53. Watkins AM, West CR, Cooke RW. Blood pressure and cerebral haemorrhage and ischaemia in very low birthweight infants. Early Hum Dev 1989; 19(2): 103–110. doi: 10.1016/0378-3782(89)90120- 5. PMID: 2737101.
54. Zhang J, Penny DJ, Kim NS, Yu VY, Smolich JJ. Mechanisms of blood pressure increase induced by dopamine in hypotensive preterm neonates. Arch Dis Child Fetal Neonatal Ed 1999; 81(2): F99–F104. doi: 10.1136/fn.81.2.f99. PMID: 10448176; PMCID: PMC1720986.
55. Zinni M, Pansiot J, Léger PL, El Kamouh M, Baud O. Sildenafilmediated neuroprotection from adult to neonatal brain injury: Evidence, mechanisms, and future translation. Cells 2021; 10(10): 2766. doi: 10.3390/cells10102766. PMID: 34685745; PMCID: PMC8534574.
Labels
NeonatologyArticle was published in
Czech and Slovak Neonatology
2022 Issue 1
Most read in this issue
- Persistent pulmonary hypertension in the newborn: pathophysiology, diagnosis and treatment
- Recent methods of perfusion measurement in newborn
- Treatment of neonatal hemodynamic compromise
- Neonatal myocardial hypertrophy