title: Noradrenaline in preterm infants with cardiovascular compromise.
abstract: Noradrenaline (NA) is beneficial in the treatment of term newborns with cardiovascular compromise due to sepsis or pulmonary hypertension, but experiences with NA in preterm infants are limited. The aim of this study is to describe the efficacy and safety of NA in preterm infants. Patient records of preterm infants ≤32 weeks' gestation admitted to two hospitals between 2004 and 2015 and who received NA were reviewed for perinatal morbidities and mortality. Clinical details were collected at the time of NA use, and response on blood pressure, perfusion and oxygenation was documented as well as possible side effects. Forty-eight infants with primary diagnoses of sepsis (63 %) and pulmonary hypertension (23 %) received NA. Normotension was achieved at a median of 1 h in all but one infant at a median dose of 0.5 mcg/kg/min. Infants who died (46 %) were of younger gestational age and had worse cardiovascular function at start of NA compared to infants who survived. Tachycardia was common (31 %), but no additional effects were found on kidney or liver function.
  
  
  CONCLUSIONS
  NA appears to be tolerated safely by preterm infants with no major side effects. However, effectiveness needs to be studies further in structured trials. What is Known: • Noradrenaline is beneficial in the treatment of term newborns and infants with cardiovascular compromise. • Noradrenaline is known for its potent vasoconstrictive effects and, therefore, infrequently used in preterm infants. What is New: • Noradrenaline used in relative low dose and as first or second line support increases blood pressure in preterm infants with cardiovascular compromise. • Tachycardia was common, but no additional side effects were found.
authors.affiliation: Australia National University, Canberra, ACT, Australia.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Rowcliff
authors.affiliation: Department of Neonatology, John Hunter Children's Hospital, Lookout road, Newcastle, NSW, 3205, Australia. koert.dewaal@hnehealth.nsw.gov.au.|University of Newcastle, Newcastle, NSW, Australia. koert.dewaal@hnehealth.nsw.gov.au.
authors.forename: Koert
authors.initials: K
authors.lastname: de Waal
authors.affiliation: Australia National University, Canberra, ACT, Australia.|Department of Neonatology, Canberra Hospital, Canberra, ACT, Australia.
authors.forename: Abdel-Latif
authors.initials: AL
authors.lastname: Mohamed
authors.affiliation: Australia National University, Canberra, ACT, Australia.|Department of Neonatology, Canberra Hospital, Canberra, ACT, Australia.
authors.forename: Tejasvi
authors.initials: T
authors.lastname: Chaudhari
mesh_terms: D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D007022:Hypotension / Q000188:drug therapy*; D007231:Infant, Newborn; D007234:Infant, Premature; D000071074:Neonatal Sepsis / Q000188:drug therapy*; D009638:Norepinephrine / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013610:Tachycardia / Q000139:chemically induced; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D014662:Vasoconstrictor Agents; D009638:Norepinephrine
keywords: Hypotension; Noradrenaline; Preterm infant