Observational study of cerebral hemodynamics during dopamine treatment in hypotensive ELBW infants on the first day of life

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Abstract

OBJECTIVE:

To evaluate cerebral hemodynamics during dopamine treatment in hypotensive (mean arterial blood pressure (MABP) STUDY DESIGN:

Continuous monitoring of cerebral blood flow velocity (CBFv), MABP and PCO2 was performed in hypotensive ELBW infants on the first day of life, beginning with an ˜15-min baseline reading and continued during advancing dopamine infusion until MABP was optimized. Physiological variables and CBFv reactivity were compared before and after MABP was optimized.

RESULT:

Fifteen hypotensive ELBW infants (625 ± 174 g; 24 (23 to 24.8) weeks) were studied. Mean CBFv increased from 10.9 ± 3.7 to 15.7 ± 5.7 cm s−1 (P = 0.001) simultaneously as MABP increased from 22.3 ± 2.8 to 35.2 ±9.7 mm Hg (P<0.001). Mean CBFv reactivity (95% confidence interval (CI)) was 3.9 (1.6 to 6.2) % mm Hg−1. Nine infants died and/or developed severe intraventricular hemorrhage (IVH).

CONCLUSION:

Mean CBFv increased pressure-passively as MABP was optimized by dopamine treatment in very sick hypotensive ELBW infants on the first day of life.

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