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On his 2nd day of life a ventilated 26-weeker has a blood-pressure mean of 21mmHg. What do you do? 74 members have voted

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The use of inotropes is a matter of discussion, and the 99nicu Poll for May 2012 is about the use inotrope use in preterm infant.

This poll is inspired by a topic at the Evidence-based neonatology (EBNEO) conference in Stockholm, June 2011. Dr Alan Groves lectured about the use of inotropes, in an excellent and thought-provoking way.

You can see this lecture in the EBNEO web cast, as the first lecture on the 2nd conference day (4 June 2011)

http://web22.abiliteam.com/ability/show/khcichp/abbott_ebneo/speed.asp

A review article by Alan Groves is also promoted as the Leading article this month.

I would use first Normal saline bolus once or twice and then start Dopamine

Firstly, I will re-calibrate my ABP transducer, secondly I will make sure that the baby is well perfused, well hydrated and not acidotic with normal serum lactate level and maintaining adequate urine out put.

I would use first Normal saline bolus once or twice and then start Dopamine

You should never give bolus infusions to a preterm infant. The word bolus means immediately like when you slap your hands.

Infusions should be given over a graded period of time. All infants with low BP should be started on dopamine. Read article from Murphy which shows clearly that beginning dopamine preserves CBF.

thanks

charlie

Dr C Paxson

Prof Peds

Michigan State Sch Med

Marquette, MI, USA

For Dr C Paxson

Sorry for misinterpretation. When I worte bolus, it means over 30min to one hour. No bolus can be given like Slap of hands. I will still insist on restoring blood volume first by giving Normal saline over 30min to one hour and then start dopamine. Starting dopamine right from the begining is not correct.

One thing more I want to add if your ABG is fine with no metabolic acidosis, normal lactate and no tachycardia with good perfusion, donot treat numbers, just wait and see.

10ml per kg NS infusion two times followed by dopamine titrate the dose upwards as required; but the next step is it dobutamine or adrenaline, I prefer adrenaline but my colleagues prefer dobutamine, what is your views?

START DOBUTAMINE TO IMPROVE BLOOD FLOW AND HENCE BLOOD PRESSURE , NO NEED FOR SALINE BOLUS AS THE PROBLEM IS NOT HYPOVOLEMIA BUT MYOCARDIAL DYSFUCTION OF THE PREMATURES

I usually use Dobutamine after NS bolus, but frequently it'll need also dopamine after that (10 mcg each)... Never had experience with adrenaline.. Please share, in what situation we use adrenaline?

premature infant have myocardial dysfunction in first 24 hours, using dobutamine after NS 10 ml/kg is better choice. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672709/

After 24 hours dopamine is better. Inotropes should be used when really needed clinically. Treating just numbers is not recommended.

I would rather start off with dobutamine and assess the response, adding dopamine if blood prrssure remained low. After 24 hours, dopamine would be my first choice.

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