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Cardiovascular support in preterm infants: A survey of practices in Australia and New Zealand
Author(s) -
Sehgal Arvind,
Osborn David,
McNamara Patrick J
Publication year - 2012
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/j.1440-1754.2011.02246.x
Subject(s) - medicine , dobutamine , milrinone , afterload , hemodynamics , inotrope , bolus (digestion) , ductus arteriosus , anesthesia , heart rate , pediatrics , intensive care medicine , blood pressure
Aim: Management of haemodynamic instability in premature neonates and selection of inotropic therapy are protocol driven, and therapeutic choices lack scientific validation. The aim of this study was to characterise practices related to the management of haemodynamic instability in premature infants. Methods: An electronic web‐based questionnaire was emailed to all neonatologists and advanced trainees in Australia and New Zealand. Respondents were presented with a series of questions related to the management of hypotension in a 1‐day‐old, extremely low birthweight infant, and opinions were collected. Results: Survey response rate was 65% (114/176). Haemodynamically significant ductus arteriosus, systemic blood flow and left ventricular afterload were considered the most important physiologic concepts by 81, 68 and 50%, respectively. After initial crystalloid replacement, the next step in management reported included a second bolus (35%), dobutamine (28%), dopamine (17%) or clinician‐performed cardiac ultrasound (CPCU) (20%). In the setting of hypotension resistant to dobutamine and dopamine, the most common strategies were to perform CPCU (57%), or administer hydrocortisone (39%), epinephrine (3.5%) or milrinone (<1%). The majority (66%) of respondents felt that premature infants are over‐treated on the basis of presumed hypotension, while 83% felt that performing a CPCU would enhance clinical decision‐making. Conclusions: Wide variation in the approach to management of haemodynamic instability in extremely low birthweight infants was identified. Haemodynamic information provided by a CPCU was considered highly desirable by the majority of the respondents.