title: Cardiovascular support in preterm infants: a survey of practices in Australia and New Zealand.
abstract: OBJECTIVE
  Management of haemodynamic instability in premature neonates and selection of inotropic therapy are protocol driven, and therapeutic choices lack scientific validation. The aim of this study was to characterise practices related to the management of haemodynamic instability in premature infants.
  
  
  METHODS
  An electronic web-based questionnaire was emailed to all neonatologists and advanced trainees in Australia and New Zealand. Respondents were presented with a series of questions related to the management of hypotension in a 1-day-old, extremely low birthweight infant, and opinions were collected.
  
  
  RESULTS
  Survey response rate was 65% (114/176). Haemodynamically significant ductus arteriosus, systemic blood flow and left ventricular afterload were considered the most important physiologic concepts by 81, 68 and 50%, respectively. After initial crystalloid replacement, the next step in management reported included a second bolus (35%), dobutamine (28%), dopamine (17%) or clinician-performed cardiac ultrasound (CPCU) (20%). In the setting of hypotension resistant to dobutamine and dopamine, the most common strategies were to perform CPCU (57%), or administer hydrocortisone (39%), epinephrine (3.5%) or milrinone (<1%). The majority (66%) of respondents felt that premature infants are over-treated on the basis of presumed hypotension, while 83% felt that performing a CPCU would enhance clinical decision-making.
  
  
  CONCLUSIONS
  Wide variation in the approach to management of haemodynamic instability in extremely low birthweight infants was identified. Haemodynamic information provided by a CPCU was considered highly desirable by the majority of the respondents.
authors.affiliation: Monash Newborn, Monash Medical Centre and Monash University, Melbourne, Victoria, Ontario, Australia. Arvind.Sehgal@southernhealth.org.au
authors.forename: Arvind
authors.initials: A
authors.lastname: Sehgal
authors.forename: David
authors.initials: D
authors.lastname: Osborn
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: McNamara
mesh_terms: D001315:Australia; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007022:Hypotension / Q000188:drug therapy*; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D009520:New Zealand; D010818:Practice Patterns, Physicians'; D047928:Premature Birth; D011446:Prospective Studies