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Children 2015, 2(2), 272-288; doi:10.3390/children2020272

Challenges in Treating Low Blood Pressure in Preterm Infants

1
Department of Paediatrics and Child Health, University College Cork, Cork City post code, Ireland
2
Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork, Ireland
3
Department of Paediatrics and Child Health, Cork University Maternity Hospital, Wilton Cork, Ireland
Academic Editors: Johannes N. van den Anker and Klaus Rose
Received: 10 April 2015 / Accepted: 5 June 2015 / Published: 15 June 2015
(This article belongs to the Special Issue Development of Medicines for Paediatric and Rare Diseases)
View Full-Text   |   Download PDF [304 KB, uploaded 15 June 2015]

Abstract

Whilst the prevalence of low blood pressure in preterm infants seems to have fallen over the last number of years, the problem is still frequently encountered in the neonatal intensive care unit and many babies continue to receive intervention. Great variability in practice persists, with a significant number of extremely low gestational age newborns in some institutions receiving some form of intervention, and in other units substantially less. A great degree of this variability relates to the actual criteria used to define hypotension, with some using blood pressure values alone to direct therapy and others using a combination of clinical, biochemical and echocardiography findings. The choice of intervention remains unresolved with the majority of centres continuing to administer volume followed by dopamine as a first line inotrope/vasopressor agent. Despite over 40 years of use there is little evidence that dopamine is of benefit both in the short term and long-term. Long-term follow up is available in only two randomised trials, which included a total of 99 babies. An under recognized problem relates to the administration of inotrope infusions in very preterm infants. There are no pediatric specific inotrope formulations available and so risks of errors in preparation and administration remain. This manuscript outlines these challenges and proposes some potential solutions. View Full-Text
Keywords: Hypotension; blood flow; dopamine; extreme preterm infant; intravetricular haemorrhage Hypotension; blood flow; dopamine; extreme preterm infant; intravetricular haemorrhage
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Dempsey, E.M. Challenges in Treating Low Blood Pressure in Preterm Infants. Children 2015, 2, 272-288.

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