Inotropes for Preterm Infants: 50 Years on Are We Any Wiser?

被引:18
作者
Garvey, Aisling A. [1 ,2 ]
Kooi, Elisabeth M. W. [1 ,3 ]
Dempsey, Eugene M. [1 ,2 ]
机构
[1] Univ Coll Cork, Neonatal Intens Care Unit, Dept Paediat & Child Hlth, Cork, Ireland
[2] Univ Coll Cork, INFANT, Irish Ctr Fetal & Neonatal Translat Res, Cork, Ireland
[3] Univ Groningen, Univ Med Ctr Groningen, Beatrix Childrens Hosp, Div Neonatol, Groningen, Netherlands
来源
FRONTIERS IN PEDIATRICS | 2018年 / 6卷
基金
爱尔兰科学基金会;
关键词
neonatology; hypotension; inotropes; preterm infants; blood pressure; end organ perfusion; LOW-BIRTH-WEIGHT; PERSISTENT PULMONARY-HYPERTENSION; INTRAVENOUS ARGININE-VASOPRESSIN; RANDOMIZED CONTROLLED-TRIAL; VASODILATORY SHOCK; SEPTIC SHOCK; CARDIOVASCULAR SUPPORT; BLOOD-PRESSURE; MILRINONE PHARMACOKINETICS; DOPAMINE INFUSIONS;
D O I
10.3389/fped.2018.00088
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
For almost half a century, inotropes have been administered to preterm infants with the ultimate goal of increasing their blood pressure. A number of trials, the majority of which focused on dopamine administration, have demonstrated increased blood pressure following inotrope administration in preterm infants and have led to continued use of inotropes in our neonatal units. We have also seen an increase in the number of potential agents available to the clinician. However, we now know that hypotension is a much broader concept than blood pressure alone, and our aim should instead be focused on improving end organ perfusion, specifically cerebral perfusion. Only a limited number of studies have incorporated the organ-relevant hemodynamic changes and long-term outcomes when assessing inotropic effects in neonates, the majority of which are observational studies or have a small sample size. In addition, important considerations, including the developing/maturing adrenergic receptors, polymorphisms of these receptors, and other differences in the pharmacokinetics and pharmacodynamics of preterm infants, are only recently being recognized. Certainly, there remains huge variation in practice. The lack of well-conducted randomized controlled trials addressing these relevant outcomes, along with the difficulty executing such RCTs, leaves us with more questions than answers. This review provides an overview of the various inotropic agents currently being used in the care of preterm infants, with a particular focus on their organ/cerebral hemodynamic effects both during and after transition.
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页数:7
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