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In Vivo Real-Time Study of Drug Effects on Carotid Blood Flow in the Ovine Fetus
Published on: April 28, 2023
Inotropes for preterm babies during the transition period after birth: friend or foe?
Heike Rabe1,2, Hector Rojas-Anaya2
1Department of Paediatrics, Brighton and Sussex Medical School, Brighton, UK.
Insights
Preterm infants face circulatory failure risk. Current treatments for hypotension lack robust evidence, prompting trials on dopamine and dobutamine efficacy and safety.
Area of Science:
- Neonatalogy
- Pediatric Cardiology
- Perinatal Medicine
Background:
- Preterm infants are vulnerable to circulatory failure after birth.
- Hypotension is a primary indicator for interventions like fluid boluses, inotropes, and steroids.
- Current treatment strategies lack extensive randomized controlled trial data for efficacy and safety.
Purpose of the Study:
- To address the knowledge gaps in assessing circulatory compromise in preterm infants.
- To evaluate the efficacy and safety of specific treatments for circulatory failure in this population.
- To inform clinical practice regarding the optimal management of hypotension in preterm neonates.
Main Methods:
- Utilizing functional echocardiography, near-infrared spectroscopy, capillary refill time, base excess, and serum lactate for circulatory assessment.
- Conducting large randomized controlled trials (RCTs) for dopamine and dobutamine.
- Focusing on preterm infants less than 32 weeks gestation.
Main Results:
- Ongoing large RCTs are investigating the use of dopamine and dobutamine.
- Evidence regarding preferred inotropes and optimal blood pressure thresholds is still developing.
- Data on the efficacy and safety of current interventions is limited.
Conclusions:
- There is a critical need for evidence-based guidelines for managing circulatory compromise in preterm infants.
- Ongoing trials are expected to provide crucial data on the use of specific pharmacological agents.
- Standardizing diagnostic measures and treatment thresholds is essential for improving outcomes.
Abstract:
During the transition to extrauterine life, preterm infants are at high risk of developing circulatory failure. Currently, hypotension is used as major diagnostic criteria for starting treatments such as fluid boluses, inotropes or steroids. Most of these treatment options have not been studied in large randomised controlled trials for efficacy and safety and are under discussions. A wide variety in their use is reported in the literature and clear evidence about which inotrope or other treatment should be preferred is lacking. In addition, there is ongoing debate about the appropriate threshold values for blood pressure. Other diagnostic measures for poor circulation are functional echocardiography, near-infrared spectroscopy, capillary refill time, base excess and serum lactate. Large randomised controlled trials for the use of dopamine and dobutamine in preterm infants <32 weeks gestation are under way to fill the knowledge gaps on the assessment of circulatory compromise and on efficacy and safety of the studied age-appropriate drug formulations.
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