Document Detail


Cardiovascular support in preterm infants: A survey of practices in Australia and New Zealand.
MedLine Citation:
PMID:  22085374     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Aim:  Management of haemodynamic instability in premature neonates and selection of inotropic therapy are protocol driven, and therapeutic choices lack scientific validation. The aim of this study was to characterise practices related to the management of haemodynamic instability in premature infants. Methods:  An electronic web-based questionnaire was emailed to all neonatologists and advanced trainees in Australia and New Zealand. Respondents were presented with a series of questions related to the management of hypotension in a 1-day-old, extremely low birthweight infant, and opinions were collected. Results:  Survey response rate was 65% (114/176). Haemodynamically significant ductus arteriosus, systemic blood flow and left ventricular afterload were considered the most important physiologic concepts by 81, 68 and 50%, respectively. After initial crystalloid replacement, the next step in management reported included a second bolus (35%), dobutamine (28%), dopamine (17%) or clinician-performed cardiac ultrasound (CPCU) (20%). In the setting of hypotension resistant to dobutamine and dopamine, the most common strategies were to perform CPCU (57%), or administer hydrocortisone (39%), epinephrine (3.5%) or milrinone (<1%). The majority (66%) of respondents felt that premature infants are over-treated on the basis of presumed hypotension, while 83% felt that performing a CPCU would enhance clinical decision-making. Conclusions:  Wide variation in the approach to management of haemodynamic instability in extremely low birthweight infants was identified. Haemodynamic information provided by a CPCU was considered highly desirable by the majority of the respondents.
Authors:
Arvind Sehgal; David Osborn; Patrick J McNamara
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-11-16
Journal Detail:
Title:  Journal of paediatrics and child health     Volume:  -     ISSN:  1440-1754     ISO Abbreviation:  -     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-11-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9005421     Medline TA:  J Paediatr Child Health     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
Affiliation:
Monash Newborn, Monash Medical Centre and Monash University, Melbourne, Victoria Neonatal Medicine, Royal Prince Alfred Hospital, and University of Sydney, Sydney, New South Wales, Australia Division of Neonatology and Physiology and Experimental Medicine Program, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
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