Cardiovascular effects of low-dose dexamethasone in very low birth weight neonates with refractory hypotension.
BACKGROUND
Administration of hydrocortisone and relatively high doses of dexamethasone increase blood pressure in volume- and pressor-resistant hypotensive preterm infants. However, little is known about the temporal relationship of dexamethasone administration and the improvement in blood pressure and the weaning of pressors/inotropes. Furthermore, there are no sufficient data available on whether a smaller dose of dexamethasone would also be effective in treating refractory hypotension.


OBJECTIVE
To study the cardiovascular responses to low-dose dexamethasone in very low birth weight neonates with volume- and pressor-resistant hypotension.


METHODS
Retrospective database review. Twenty-four preterm neonates (gestational age 26 (23-34) weeks; birth weight 801 (457-1,180) g; postnatal age 2 (1-24) days, medians (ranges)) who remained hypotensive despite volume administration and combined dopamine and dobutamine treatment at >or=30 microg/kg/min received dexamethasone 0.1 mg/kg followed by 0.05 mg/kg intravenously every 12 h for 5 additional doses if still on pressors >or=8 microg/kg/min.


RESULTS
Two hours after the first dose of dexamethasone the mean blood pressure increased from 30 +/- 5 to 34 +/- 6 mm Hg (p < 0.001) and remained elevated at 4, 6, 12, and 24 h after treatment was started (p < 0.001). Six hours after the initial dose of dexamethasone the pressor/inotrope requirement decreased from 34 +/- 9 to 24 +/- 13 microg/kg/min (p = 0.001) and continued to decrease at 12 and 24 h (p < 0.001). Urine output also increased significantly during the first 6 h after dexamethasone (p < 0.001).


CONCLUSIONS
Low-dose dexamethasone rapidly increases blood pressure and decreases pressor requirements in very low birth weight neonates with volume- and pressor-resistant hypotension.
Noori
Shahab
S
USC Division of Neonatal Medicine, Childrens Hospital Los Angeles, CA 90027, USA. snoori@chla.usc.edu
Siassi
Bijan
B
Durand
Manuel
M
Acherman
Ruben
R
Sardesai
Smeeta
S
Ramanathan
Rangasamy
R
D002319:Cardiovascular System / Q000187:drug effects*; D003907:Dexamethasone / Q000008:administration & dosage*; D004280:Dobutamine / Q000008:administration & dosage; D004298:Dopamine / Q000008:administration & dosage; D005865:Gestational Age; D006801:Humans; D007022:Hypotension / Q000188:drug therapy*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy*; D019102:Infant, Very Low Birth Weight; D012189:Retrospective Studies
D004280:Dobutamine; D003907:Dexamethasone; D004298:Dopamine