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Updated: Jun 8, 2026
Non-invasive Optical Measurement of Cerebral Metabolism and Hemodynamics in Infants
Published on: March 14, 2013
Acute effects of levosimendan on cerebral and systemic perfusion and oxygenation in newborns: an observational study
María Carmen Bravo1, María del Carmen Bravo, Paloma López
1Department of Neonatology, La Paz University Hospital, Madrid, Spain. m.bravo.laguna@gmail.com
Insights
Levosimendan improves cerebral and systemic oxygenation in critically ill infants with low cardiac output syndrome. This inodilator enhances perfusion and reduces heart rate and lactate levels.
Area of Science:
- Pediatric Cardiology
- Neonatal Intensive Care
- Pharmacology
Background:
- Cardiovascular drugs are crucial for neonates with congenital heart disease.
- Management focuses on contractility, preload, and afterload.
- Levosimendan is an inodilator enhancing contractility and vasodilation.
Purpose of the Study:
- To evaluate the acute hemodynamic effects of levosimendan in critically ill infants with low cardiac output syndrome (LCOS).
Main Methods:
- Infants received stepwise levosimendan infusions (0.1-0.2 μg/kg/min) for 48 hours.
- Near-infrared spectroscopy monitored cerebral and peripheral perfusion and oxygenation.
- Blood pressure, heart rate, lactate, and blood gases were continuously recorded.
Main Results:
- Levosimendan increased cerebral oxygenation (cΔHbD) and decreased heart rate and lactate.
- Peripheral oxygenation (pΔHbD) showed non-significant increases.
- Blood pressure changes and levosimendan were independently associated with improved cerebral oxygenation.
Conclusions:
- Levosimendan effectively improves cerebral and systemic perfusion and oxygenation.
- It is a beneficial agent for critically ill infants experiencing low cardiac output syndrome.
Background:
Cardiovascular drugs play a major role in the pre- and postoperative care in neonates with congenital heart disease. Management strategies aim to optimise contractility, improve diastolic function, maintain adequate preload, and reduce afterload. Levosimendan, a novel inodilator agent, enhances myocardial contractility and causes peripheral and coronary vasodilation.
Objectives:
A systematic approach was used to evaluate the acute haemodynamic effects of levosimendan in critically ill infants with low cardiac output syndrome (LCOS).
Methods:
Infants received a continuous infusion of levosimendan, at a dose increased stepwise (range 0.1-0.2 μg/kg/min), during 48 h. Two near-infrared units were used to assess cerebral (frontal-parietal, c) and peripheral (thigh, p) perfusion and oxygenation. The changes in cerebral blood volume (ΔCBV), cerebral (cΔHbD) and peripheral (pΔHbD) intravascular oxygenation and the cerebral (cTOI) and peripheral (pTOI) tissue oxygenation index that followed levosimendan administration were continuously monitored. Blood pressure, heart rate, and temperature were continuously recorded. In addition, baseline and end-of-study pH, blood gases, lactate and haematocrit were determined.
Results:
Seven doses of levosimendan were investigated. The mean study time was 13.3 (7-19) h. Levosimendan produced an increase in cΔHbD (p < 0.05) and pΔHbD (NS) and a decrease in heart rate (p < 0.001) and lactate (p < 0.05). Trends showed an increase in mean blood pressure (NS). These results were independent of the effect of time. Mixed linear model analysis identified blood pressure changes and levosimendan as factors independently associated with cΔHbD.
Conclusions:
Levosimendan improves cerebral and systemic perfusion and oxygenation in critically ill infants suffering from LCOS.
