Right Ventricular Performance in Hypotensive Preterm Neonates Treated with Dopamine

Abstract

Systemic hypotension with left ventricular dysfunction is a common complication of neonatal respiratory distress syndrome and is often treated with inotropic agents. Although pulmonary hypertension with elevated pulmonary vascular resistance is also an important pathophysiological finding in respiratory distress syndrome, the effect of inotropes on the right ventricle has not been studied. The aim of this study was to assess changes in right ventricular dimensions and function with inotropic therapy in hypotensive preterm infants. Hypotensive neonates with respiratory distress syndrome were studied before and 1 hour after the initiation of a dopamine infusion. Right ventricular performance was assessed by two-dimensional echocardiography using the ellipsoid approximation method. Eight hypotensive neonates were recruited with a median (interquartile range) gestation of 27 weeks (26 to 27 weeks). Right ventricular end systolic volume decreased significantly from a median (interquartile range) of 1.06 ml/kg (0.81-1.50 ml/kg) to 0.73 ml/kg (0.51-0.99 ml/kg) (p < 0.01) 1 hour following dopamine therapy. Right ventricular end diastolic volume did not change significantly. Right ventricular ejection fraction increased significantly from 0.36 (0.29-0.46) to 0.51 (0.43-0.53) ( p < 0.01). There was a trend toward an increase in right ventricular output from 90 ml/kg/min (67-115 ml/kg/min) to 112 ml/kg/min-143 ml/kg/min) (p=0.07). Dopamine increases right ventricular ejection fraction through a reduction in right ventricular end systolic volume.