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Inotropes in preterm infants--evidence for and against
1Centre for the Developing Brain, Imperial College London and MRC Clinical Sciences Centre, London, UK.
Insights
Optimal circulatory management for preterm infants requires assessing multiple circulatory function aspects, not just blood pressure. Tailor inotropic therapies based on desired functional changes and reassess interventions frequently for best outcomes.
Area of Science:
- Neonatal physiology and pathophysiology
- Pediatric critical care medicine
- Hemodynamic monitoring in neonates
Background:
- Limited safe and reproducible biomarkers hinder optimal circulatory management in preterm infants.
- Understanding circulatory function is crucial for transitional care, sepsis, and necrotizing enterocolitis in neonates.
Purpose of the Study:
- To review the physiology and pathophysiology of circulatory function in preterm infants.
- To evaluate evidence for and against inotropic therapies in neonates.
- To provide recommendations for managing circulatory dysfunction in preterm infants.
Main Methods:
- Literature review of physiology, pathophysiology, and inotropic therapies.
- Analysis of evidence supporting and refuting common and novel inotropic agents.
- Development of a pragmatic management approach based on functional assessment.
Main Results:
- Blood pressure alone is a weak correlate of circulatory flow volume.
- A multi-faceted assessment of circulatory function is superior to isolated measures.
- Evidence for and against various inotropic therapies is critically evaluated.
Conclusions:
- A pragmatic, multi-system approach to circulatory assessment is recommended for preterm infants.
- Therapeutic interventions should be individualized based on desired functional outcomes.
- Frequent reassessment of response to interventions is essential for effective management.
Abstract:
There is significant uncertainty regarding the optimal circulatory management of preterm infants, with research in the field limited by the paucity of safe, reproducible biomarkers of circulatory function. This review discusses the physiology and pathophysiology of circulatory function in preterm infants, describes the mode of action and evidence for and against commonly used and recently trialled inotropic therapies and provides recommendations for managing circulatory dysfunction in the transitional period and in the context of sepsis/necrotizing enterocolitis. We recommend a pragmatic approach of assessing multiple aspects of circulatory function (blood pressure alone correlates weakly with volume of flow) in each infant, tailoring therapy on the basis of the change in function desired and frequently reassessing response to intervention.
