Abstract
Asphyxiated neonates often have hypotension, shock, and poor tissue perfusion. Various “inotropic” medications are used to provide cardiovascular support to improve the blood pressure and to treat shock. However, there is incomplete literature on the examination of hemodynamic effects of these medications in asphyxiated neonates, especially in the realm of clinical studies (mostly in late preterm or term populations). Although the extrapolation of findings from animal studies and other clinical populations such as children and adults require caution, it seems appropriate that findings from carefully conducted pre-clinical studies are important in answering some of the fundamental knowledge gaps. Based on a literature search, this review discusses the current available information, from both clinical studies and animal models of neonatal asphyxia, on common medications used to provide hemodynamic support including dopamine, dobutamine, epinephrine, milrinone, norepinephrine, vasopressin, levosimendan, and hydrocortisone.
Highlights
Asphyxia is a clinico-pathological condition that is caused by a hypoxic-ischemic insult resulting in dysfunction of one or more organ systems in over 80% of asphyxiated neonates [1, 2]
It is important to be cognizant of a hemodynamic state that evolves through feto-neonatal transition in the course of an asphyxiating disease and recovery, as well as the interaction between hemodynamics and concurrent treatments including respiratory state and positive pressure ventilation, and therapeutic hypothermia (TH)
pulmonary hypertension (PHT) of asphyxiated neonates has a multitude of effects on the compromised myocardium including decreased systemic blood flow, increased right ventricular afterload and stress, increased cardiac transmural pressure with decreased perfusion in the subendocardial layer, and aggravated systemic hypoxemia with right-to-left shunting across a patent ductus arteriosus and foraman ovale [64,65,66]
Summary
Asphyxia is a clinico-pathological condition that is caused by a hypoxic-ischemic insult resulting in dysfunction of one or more organ systems in over 80% of asphyxiated neonates [1, 2]. Cardiovascular support is often provided using a myriad of medications to treat the complex and heterogeneous etiologies of hemodynamic compromise or instability in asphyxiated neonates. The challenge for clinicians caring for asphyxiated neonates is to understand the pathophysiology of hemodynamic disturbances and provide an individualized therapy to the patient. It is important to be cognizant of a hemodynamic state that evolves through feto-neonatal transition in the course of an asphyxiating disease and recovery, as well as the interaction between hemodynamics and concurrent treatments including respiratory state and positive pressure ventilation, and therapeutic hypothermia (TH)
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