Abstract
Objective: To describe mean arterial blood pressure (MABP), responsiveness to dopamine, and relationship to brain injury in infants with moderate/severe hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH). We hypothesized that, when utilized, dopamine would rapidly and effectively increase MABP in treated patients.Methods: Continuous arterial blood pressure measurements were prospectively recorded from infants with moderate/severe HIE undergoing TH in a multi-institutional cohort from 2010 to 2018. Treatment with dopamine was at the discretion of the medical team for hypotension/hypoperfusion. MABP values of treated infants were compared to those obtained at an equivalent time period in control infants receiving TH but not dopamine (24 h after birth). MRI was obtained per unit protocols and included T1/T2/DWI sequences. Injury was classified as no injury/mild injury or moderate/severe injury using a standardized scoring system. Seizures were confirmed with conventional EEG.Results: Eighteen infants were treated with dopamine and were similar to untreated controls (n = 36) with the exception of lower cord gas pH (6.92 ± 0.2 vs. 7.07 ± 0.2, p < 0.05). Dopamine was initiated at a mean of 24 h after birth. MABP was significantly lower in the dopamine group at the start of therapy (39.9 ± 2.0 vs. 49.1 ± 1.3, p < 0.01) and 1 h later (44.3 ± 2.0 vs. 49.8 ± 1.1, p < 0.05). However, after 9 h of treatment, dopamine increased the MABP by an average of 9 mmHg and MABP values were similar to untreated controls for the remainder of the observation period. There were no significant differences in rates of seizures, brain injury, or death.Conclusion: Neonates with moderate/severe HIE treated with dopamine during TH had MABP significantly lower than controls. The majority of infants responded to dopamine monotherapy following adequate volume resuscitation. An association between requirement for dopamine and severity of brain injury was not detected.
Highlights
Hypoxic-ischemic encephalopathy (HIE) secondary to birth asphyxia is a significant cause of neonatal morbidity and mortality, affecting 1-8/1,000 live births in developed countries [1]
We evaluate the blood pressure response to dopamine in infants diagnosed with hypotension/hypoperfusion after moderate/severe HIE treated with Therapeutic hypothermia (TH)
98 infants were diagnosed with moderate-severe encephalopathy and had arterial lines placed at St. Louis Children’s Hospital (SLCH)
Summary
Hypoxic-ischemic encephalopathy (HIE) secondary to birth asphyxia is a significant cause of neonatal morbidity and mortality, affecting 1-8/1,000 live births in developed countries [1]. Injury arises from an imbalance between oxygen supply and demand leading to a clinical syndrome known as HIE. The clinical presentation of HIE is broad with signs and symptoms ranging from mild encephalopathy to multi-organ system failure, autonomic instability, absence of primitive reflexes, seizures, and death [4, 5]. Therapeutic hypothermia (TH) became the standard of care for moderate to severe HIE after multiple randomized control trials demonstrated a reduction in the combined outcome of death or moderate-severe disability [6,7,8,9]. Adjunctive interventions in targeted populations are needed to further reduce morbidity and mortality
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