Nicardipine to control neonatal hypertension during extracorporeal membrane oxygen support.
OBJECTIVE
To describe the clinical course of a newborn (gestational age 38 wk, 6 d) administered intravenous nicardipine to control hypertension while on extracorporeal membrane oxygen (ECMO) support.


METHODS
Urban, university teaching hospital.


METHODS
A 1-day-old male neonate presenting with a left congenital diaphragmatic hernia developed a sustained elevation in blood pressure following a change of ECMO tubing. After several unsuccessful treatment regimens, nicardipine was started at a rate of 0.5 micro g/kg/min and aggressively titrated to 1.5 micro g/kg/min. Nicardipine produced a sustained antihypertensive effect that was noticed 8 hours after the start of the infusion. The infusion was continued through postoperative day 2. Following a second circuit change, nicardipine was discontinued and sodium nitroprusside therapy was started. Treatment with nitroprusside failed to lower the blood pressure.


CONCLUSIONS
Nicardipine is an effective antihypertensive agent for neonates receiving ECMO therapy. However, the expanded volume of distribution caused by the ECMO circuit may result in a reduced serum concentration and a reduced antihypertensive effect.


CONCLUSIONS
We recommend a conservative initial dose of nicardipine of 0.5 micro g/kg/min that is aggressively titrated to reduce blood pressure effectively in neonates receiving ECMO therapy.
McBride
Brian F
BF
Hartford Hospital, Hartford, CT, USA.
White
C Michael
CM
Campbell
Margaret
M
Frey
Bruce M
BM
D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007231:Infant, Newborn; D007275:Injections, Intravenous; D008297:Male; D009529:Nicardipine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D009599:Nitroprusside / Q000627:therapeutic use
D000959:Antihypertensive Agents; D009599:Nitroprusside; D009529:Nicardipine