Hypotension in preterm infants.
OBJECTIVE
Hypotension is a frequent occurrence in sick preterm neonates. It is important to appropriately recognise and treat hypotension in preterm infants due to the possible association with short and long term adverse outcomes.


METHODS
An extensive search for relevant articles was carried out on PubMed, Embase and Cochrane database of systematic reviews. Cross references were hand searched.


CONCLUSIONS
The pathophysiology hypotension in preterm infants is multifactorial. Hypovolemia plays only a minor role in the absence of overt fluid losses. Cardiac dysfunction seems to be a factor in some neonates. Assessment of hypotension should be based on an overall clinical condition. Overzealous fluid administration seems to be associated with adverse outcomes and should be avoided in the absence of obvious fluid losses. Inotropes should be used if fluid boluses fail to correct hypotension. Dopamine is the most effective inotrope. Dobutamine can be used as add on therapy or as first line if cardiac dysfunction is an obvious cause. Evidence points to hypocortisolism in at least some hypotensive infants. Steroids have been used successfully in inotrope-resistant hypotension in some infants. Steroids should be used judiciously since there have been concerns about adverse neurological outcome in preterm infants who received steroids in the neonatal period.
Ibrahim
C P Hafis
CP
Neonatal Unit, Liverpool Womens Hospital, Crown Street, Liverpool, United Kingdom L8 7SS. hafisibrahim@hotmail.com
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D001794:Blood Pressure; D002302:Cardiac Output / Q000187:drug effects; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004280:Dobutamine / Q000627:therapeutic use; D004298:Dopamine / Q000627:therapeutic use; D006801:Humans; D007022:Hypotension / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D007231:Infant, Newborn; D007234:Infant, Premature; D012307:Risk Factors; D013566:Sympathomimetics / Q000627:therapeutic use; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
D000318:Adrenergic beta-Agonists; D002316:Cardiotonic Agents; D013566:Sympathomimetics; D004280:Dobutamine; D004298:Dopamine