Single-dose dexamethasone treatment of hypotension in preterm infants☆,☆☆
Section snippets
Definition of Arterial Hypotension
Arterial hypotension was defined as directly measured mean arterial blood pressure readings lower than the individually determined minimum blood pressure. Because there are no reliable reference values for arterial blood pressure in very premature born infants, an individual minimum blood pressure was established for each infant and defined as the pressure required to maintain adequate diuresis at a capillary filling time of <2 to 3 seconds. For orientation the following minimum blood pressure
Sample
Between November 1994 and June 1996, 20 newborn infants were enrolled. Three were excluded later from the analysis. Between August 1996 and July 1997, 2 further children were enrolled in the study. In 1 of these children (placebo), hypertrophic obstructive cardiomyopathy led to exclusion from the study. Thus in July 1997, a group of 17 very low birth weight infants, 8 of whom were in the DXM group and 9 in the placebo group, was evaluated. Based on a new calculation of power, we decided to
DISCUSSION
Consistent with our retrospective cohort study14 we now show in a double-blind, placebo-controlled study that a single dose of 0.25 mg DXM is effective within 12 hours in improving severe arterial hypotension in preterm infants unresponsive to volume expansion and dopamine infusion. This effect was also seen after rescue administration of DXM at the end of the 12-hour study period.
Five infants, 3 of the study group and 2 after rescue treatment with DXM, had a delayed response to DXM within 13
References (29)
- et al.
Mean arterial blood pressure changes in premature infants and those at risk for intraventricular hemorrhage
J Pediatr
(1990) Blood pressure and cerebral ischemia in very low birth weight infants
J Pediatr
(1990)- et al.
Blood pressure ranges in premature infants. I. The first hours of life
J Pediatr
(1994) - et al.
Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1500 g
J Pediatr
(1978) Cardiovascular, renal and endocrine actions of dopamine in neonates and children
J Pediatr
(1995)- et al.
Mean arterial blood pressure and neonatal cerebral lesions
Arch Dis Child
(1987) - et al.
Blood pressure fluctuation and intraventricular hemorrhage in the preterm infant of less than 31 weeks gestation
Pediatrics
(1989) - et al.
Influence of acidosis, hypoxemia and hypotension on neurodevelopmental outcome in very low birth weight infants
Pediatrics
(1995) - et al.
Neonatal risk factors for cerebral palsy in very preterm babies: case-control study
BMJ
(1997) - et al.
Effect of gestational age, postnatal age and illness on plasma cortisol concentrations in premature infants (abstract)
Pediatr Res
(1995)
Glucocorticoid-responsive hypotension in extremely low birth weight newborns
Pediatrics
Response to ACTH in the newborn
Arch Dis Child
Hydrocortisone replacement in extremely premature infants with cortisol insufficiency (abstract)
Clin Res
Addisonian crisis in extremely premature neonates (abstract)
Clin Res
Cited by (115)
Corticosteroid use in neonatal hypotension: A survey of Canadian neonatologists
2024, Pediatrics and NeonatologyClinical Trials in Hemodynamic Support: Past, Present, and Future
2020, Clinics in PerinatologyCitation Excerpt :Corticosteroids have been utilized for both prevention and treatment of hypotension.3 The treatment trials have been performed as either the primary agent to treat37 or as a second-line agent.38,39 All studies are characterized by small recruitment numbers, but their use has been associated with an increase BP and a reduction in the duration of inotrope administered.
Corticosteroids for Neonatal Hypotension
2020, Clinics in PerinatologyCitation Excerpt :Dexamethasone and hydrocortisone are the two steroids that are typically used in the NICU; however, dexamethasone for treatment of refractory hypotension has fallen out of favor because of concerns over long-term neurodevelopmental outcomes. Dexamethasone improves cardiovascular function and increases BP via its glucocorticoid effects.54–57 As mentioned earlier, the main concern with dexamethasone exposure is the risk of poor neurodevelopmental outcomes among preterm infants.
Principles of developmental cardiovascular physiology and pathophysiology
2018, Hemodynamics and Cardiology: Neonatology Questions and ControversiesThe neonate with relative adrenal insufficiency and vasopressor resistance
2018, Hemodynamics and Cardiology: Neonatology Questions and ControversiesCardiovascular Compromise in the Newborn
2018, Avery's Diseases of the Newborn: Tenth Edition
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Reprint requests: Frank Pohlandt, MD, Universitätskinderklinik Ulm, D-89070 Ulm, Germany.
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