Article Text

NOREPINEPHRINE: EFFECTIVE IN NEONATAL HYPOTENSION?
  1. T vanBalen1,
  2. W P deBoode1,
  3. K D Liem1
  1. 1Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

Abstract

Introduction Neonatal hypotension is a common problem on neonatal intensive care units. Being associated with increased morbidity and mortality, its treatment is an important issue. Norepinephrine is a vasoactive agent that is not frequently used for treatment of neonatal hypotension. The aim of this study was to evaluate the effectiveness and safety of norepinephrine as treatment of neonatal hypotension.

Methods We retrospectively analysed patient data and circulatory parameters of neonates with hypotension that had been treated with norepinephrine between January 2005 and December 2006.

Results Seventy-five neonates have been found (gestational age 34.3 ± SD 5.7 weeks; birth weight 2353 ± SD 1084 g). Norepinephrine significantly increased blood pressure by 4.5 mm Hg (p<0.001). The effectiveness of norepinephrine was independent from gestational age, cause of hypotension or preceding treatment. However, in 48.4% of these patients additional treatments were needed for further increasing the blood pressure to achieve normotension, dexamethasone being most frequently prescribed. No significant differences in patient characteristics have been found between patients needing additional treatment and patients who did not need additional treatment. No serious irreversible side effects were noted.

Conclusions Norepinephrine is effective in raising blood pressure in hypotensive neonates, without causing major short-term side effects. However, in half of the cases the increased blood pressure is clinically insufficient to achieve normotension. As this is a retrospective study, these results need to be interpreted with caution. Further (prospective, randomised) study is needed to evaluate effects of norepinephrine on systemic blood flow in the case of compromised circulation.

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