Impact of inotropes on cerebral blood flow in acute period of severe hypoxic-ischemic encephalopathy in term infants

Abstract

OBJECTIVE. To determine impact of dopamine and dobutamine administration on cerebral blood flow in acute period of severe hypoxic-ischemic encephalopathy in neonates.MATERIALS AND METHODS. Data of 205 term infants with Apgar score at birth of 7 or less and Sarnat stage II-III collected during 72 hours of life. The relationships between mean blood pressure, RI and PI using dopamine and dobutamine during the first three days of the acute period of severe hypoxic-ischemic encephalopathy were analyzed.RESULTS AND DISCUSSION. During first three days of treatment no significant difference was found in mean blood pressure and cerebral blood flow administering dobutamine or combination of dobutamine and dopamine as inotropic support.In the acute period of HIE comparing to dobutamine if dopamine administered Resistant Index of cerebral arteries (RI) changed negatively, namely: dopamine administration on Day 1 of treatment led to decrease in RI during the first day of treatment (p = 0.021). The use of dopamine in 2nd day led to decrease in RI on 2nd day (p = 0.033) as well as on the 3rd day of the study (p = 0.016). The using of dopamine during the 3rd day was associated with decrease in the Pulsatile Index (PI) in the 3rd day of the study (p = 0.023).CONCLUSIONS. The administration of single dopamine or in combination with dobutamine leads to deterioration of cerebral perfusion, namely, a significant decrease in the resistance of the cerebral vessels, which is an unwanted prognostic sign for the short-term outcomes and complications of HIE.