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Noradrenaline in preterm infants with cardiovascular compromise

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Abstract

Noradrenaline (NA) is beneficial in the treatment of term newborns with cardiovascular compromise due to sepsis or pulmonary hypertension, but experiences with NA in preterm infants are limited. The aim of this study is to describe the efficacy and safety of NA in preterm infants. Patient records of preterm infants ≤32 weeks’ gestation admitted to two hospitals between 2004 and 2015 and who received NA were reviewed for perinatal morbidities and mortality. Clinical details were collected at the time of NA use, and response on blood pressure, perfusion and oxygenation was documented as well as possible side effects. Forty-eight infants with primary diagnoses of sepsis (63 %) and pulmonary hypertension (23 %) received NA. Normotension was achieved at a median of 1 h in all but one infant at a median dose of 0.5 mcg/kg/min. Infants who died (46 %) were of younger gestational age and had worse cardiovascular function at start of NA compared to infants who survived. Tachycardia was common (31 %), but no additional effects were found on kidney or liver function.

Conclusion: NA appears to be tolerated safely by preterm infants with no major side effects. However, effectiveness needs to be studies further in structured trials.

What is Known:

• Noradrenaline is beneficial in the treatment of term newborns and infants with cardiovascular compromise.

• Noradrenaline is known for its potent vasoconstrictive effects and, therefore, infrequently used in preterm infants.

What is New:

• Noradrenaline used in relative low dose and as first or second line support increases blood pressure in preterm infants with cardiovascular compromise.

• Tachycardia was common, but no additional side effects were found.

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Abbreviations

NA:

Noradrenaline

NDI:

Neurodevelopmental impairment

SVR:

Systemic vascular resistance

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Authors’ contributions

Kirsten Rowcliff was responsible for data extraction, data analysis and author of the original draft of the manuscript.

Koert de Waal was responsible for protocol development, data analysis and writing of the manuscript.

Abdel-Latif Mohamed was responsible for protocol development, data analysis and writing of the manuscript.

Tejasvi Chaudhari was responsible for protocol development, data analysis and writing of the manuscript.

Author information

Authors and Affiliations

  1. Australia National University, Canberra, ACT, Australia

    Kirsten Rowcliff, Abdel-Latif Mohamed & Tejasvi Chaudhari

  2. Department of Neonatology, John Hunter Children’s Hospital, Lookout road, Newcastle, NSW, 3205, Australia

    Koert de Waal

  3. University of Newcastle, Newcastle, NSW, Australia

    Koert de Waal

  4. Department of Neonatology, Canberra Hospital, Canberra, ACT, Australia

    Abdel-Latif Mohamed & Tejasvi Chaudhari

Authors
  1. Kirsten Rowcliff
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  2. Koert de Waal
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  3. Abdel-Latif Mohamed
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  4. Tejasvi Chaudhari
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Corresponding author

Correspondence to Koert de Waal.

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Funding

No funding was obtained for this study.

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was waived for this retrospective chart review.

Additional information

Communicated by Patrick Van Reempts

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Rowcliff, K., de Waal, K., Mohamed, AL. et al. Noradrenaline in preterm infants with cardiovascular compromise. Eur J Pediatr 175, 1967–1973 (2016). https://doi.org/10.1007/s00431-016-2794-7

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  • DOI: https://doi.org/10.1007/s00431-016-2794-7

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