Cardiovascular impact of dobutamine in neonates with myocardial dysfunction

Abstract

Objective To study effects of dobutamine on cardiac functional parameters, cerebral, mesenteric and renal blood flow in preterm neonates with myocardial dysfunction. Study design Prospective evaluation of Doppler sonographically measured left ventricular systolic time intervals, stroke volume (SV), cardiac output (CO), and blood flow parameters of anterior cerebral artery (ACA), superior mesenteric artery (SMA) and renal arteries (RA), before, after 20 min and 8–10 h of dobutamine treatment in 20 neonates (gestational age 29.6 ± 4.4 weeks, birth weight 1450 ± 609 g and postnatal age 2 ± 2.1 days). Dobutamine was given in a mean dosage of 9.1 ± 1.1 μg/kg. Results After 20 min SV increased from 1.71 ± 0.5 ml to 2.12 + 0.57 ml/kg, CO from 223 ± 76 to 290 ml/kg/min. A shortening of left ventricular pre ejection period from 86 ± 12 to 66 ± 13 ms and of the ratio of pre-ejection period/ejection time from 0.52 ± 0.12 to 0.40 ± 0.11 were observed. Blood flow velocities of ACA increased after 8–10 h: peak systolic flow velocity (PSV) from 19.0 ± 6 to 29.6 ± 7.1 ms, end diastolic velocity (EDV) from 2.9 ± 2.6 to 12.7 ± 11.3 ms. PSV of SMA increased from 32.5 ± 4.7 to 49.7 ± 7.8 ms after 8–10 h, EDV from 8.9 ± 8 ms to 20.6 ± 6.1 ms. PSV of RA increased from 18.2 ± 6.1 ms to 39.9 ± 4.8 ms, EDV from 2.2 ± 1.2 to 8.2 ± 2.1 ms after 8–10 h. The pulsatility indices decreased significantly after 8–10 h: ACA from 2.3 ± 0.6 to 1.4 ± 0.5, SMA from 1.7 to 1.2 and RA from 2.57 to 1.57. Conclusion Dobutamine improves the cardiac functional parameters already after 20 min and has an influence on the blood flow parameters of ACA, SMA and RA 8–10 h after administration in neonates with myocardial dysfunction.