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Vasoactive compounds in the neonatal period.
MedLine Citation:
PMID:  22876900     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Sufficient organ blood flow of healthy newborn babies is maintained by relatively low systemic blood pressure. Premature infants are at an increased risk of systemic hypotension, often but not obviously, resulting in hypoperfusion of the cerebral, renal and intestinal vascular beds. Maintaining a stable blood pressure in preterm babies is of high importance in order to prevent complications such as intraventricular hemorrhage, periventricular leucomalatia, necrotizing enterocolitis or renal failure. The regulation of systemic and local hemodynamics in newborns differs substantially from that of adults. Developmental changes in catecholamine sensitivity, higher local vasodilator factor activity and structural differences of the immature myocardium should be taken into account when applying vasoactive agents in neonates. The effects of widely used catecholamines such as dopamine, epinephrine or dobutamine can not be directly adapted from adult therapeutics to neonatal care. Their administration should be supported by data on their effects on systemic and cerebral blood flow in addition to blood pressure changes. From the bedside, neonatologists should use new diagnostic tools to differentiate between neonatal hypotension and hypoperfusion, vasoconstriction and myocardial dysfunction in order to choose the appropriate medication. Newer vasoactive agents already used in adult or pediatric cardiovascular therapy such as milrinone, levosimendan or terlipressin need very careful evaluation before their introduction in the treatment of neonatal hypotensive states. Well-designed preclinical and human newborn studies also evaluating their local effects are warranted.
Authors:
Peter Toth-Heyn; Danilo Buonsenso; Luigi Cataldi
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-09
Journal Detail:
Title:  Current medicinal chemistry     Volume:  -     ISSN:  1875-533X     ISO Abbreviation:  Curr. Med. Chem.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9440157     Medline TA:  Curr Med Chem     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Ist Department of Pediatrics Pediatric Intensive Care Unit, Semmelweis University, Bokay J. u. 53. 1083 Budapest, Hungary. totheyn@gyer1.sote.hu.
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