Document Detail


Developmental changes in catecholamine requirement, volume load and corticosteroid supplementation in premature infants born at 22 to 28 weeks of gestation.
MedLine Citation:
PMID:  20627428     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Due to circulatory instability, premature infants require volume loads, catecholamines and steroid supplementation to improve mortality and neurodevelopmental outcome. However, a complete quantitative analysis concerning the relationship between supplementation and gestational age, especially in infants born at 22 to 24 weeks of gestation, is lacking.
AIM: To investigate whether less mature infants need higher doses of catecholamine, volume loads and steroid, and whether those who require higher doses have poorer outcome. Study design: A retrospective, observational study was performed at a tertiary center in a university setting. Among the consecutive 221 premature infants born at 22 to 28 weeks of gestation, we selected 108 infants who had no apparent pathological conditions other than prematurity. Catecholamines, volume loads and steroid, given to attain sufficient blood pressure and urinary output, were quantitatively analyzed during the first 24 hours. Outcome measures: Quantity of catecholamines, volume expanders and steroid supplementation as a function of gestational age and childhood outcome at 2 years.
RESULTS: Catecholamines and volume loads were increased in a step-wise manner with decreasing gestational age. Intact survival rate was significantly lower in infants born before 25 weeks of gestation compared with the more mature infants. Among infants born at 22 to 24 weeks' gestation, catecholamine and volume load increased significantly in poor outcome infants compared with good outcome infants.
CONCLUSIONS: From a developmental viewpoint, progressively larger doses of catecholamine, volume expanders and corticosteroid are required to stabilize circulatory adaptation to neonatal life in infants between 22 to 28 weeks of gestation.
Authors:
Kaori Michikata; Hiroshi Sameshima; Kaeko Sumiyoshi; Yuki Kodama; Masatoki Kaneko; Tsuyomu Ikenoue
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Early human development     Volume:  86     ISSN:  1872-6232     ISO Abbreviation:  Early Hum. Dev.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-08-03     Completed Date:  2010-12-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7708381     Medline TA:  Early Hum Dev     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  401-5     Citation Subset:  IM    
Copyright Information:
2010 Elsevier Ltd. All rights reserved.
Affiliation:
Department of Obstetrics and Gynecology and Center for Perinatal Medicine, University of Miyazaki, Japan.
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / administration & dosage*,  pharmacology
Blood Pressure / drug effects
Blood Volume / drug effects*,  physiology
Cardiotonic Agents / administration & dosage*,  pharmacology
Catecholamines / administration & dosage*,  pharmacology
Endothelium, Vascular
Gestational Age
Humans
Hypovolemia / mortality,  therapy*
Infant, Newborn
Infant, Premature / blood*,  growth & development,  metabolism
Retrospective Studies
Treatment Outcome
Vasoconstrictor Agents / administration & dosage*,  pharmacology
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Cardiotonic Agents; 0/Catecholamines; 0/Vasoconstrictor Agents

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