There are many causes of hemodynamic instability in the neonate, with up to half of very low birth weight (VLBW) infants exhibiting evidence of low cardiac output and poor myocardial contractility within the first 12 hours of life. Failure to appropriately identify and address the causes of hypotension can lead to dramatic consequences in this vulnerable population. Pharmacotherapy is employed to provide action at specific receptors that result in improved cardiac output, relaxation and vasodilation of smooth muscle, as well as specific effects on the kidneys. Although the common agents have been used for decades, there are new developments in therapy. Refinements on patient selection, managing expected side effects, and effective dosing and have continued to evolve.
Learning Objectives:
1. Describe how medications used to treat hypotension are thought to work in the neonate.
2. List the common side effects of the discussed medications when used in the neonate.
3. List the usual indications for the use of epinephrine, dopamine, dobutamine, hydrocortisone, milrinone, norepinephrine, vasopressin in the neonatal patient.
4. Describe the usual ways to treat catecholamine extravasation.
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