Diagnostic criteria and therapeutic interventions for the hypotensive very low birth weight infant

• Published in: Journal of Perinatology Vol. 26; no. 11; pp. 677 - 681
• Main Authors: Dempsey, E M, Barrington, K J
• Format: Journal Article
• Language: English
• Published: United States Nature Publishing Group 01.11.2006
• Subjects: Bicarbonates; Birth weight; Birth weight, Low; Blood Pressure; Canada; Care and treatment; Complications and side effects; Criteria; Diagnosis; Diagnostic systems; Dobutamine; Dopamine; Drug therapy; Epinephrine; Fluid Therapy; Gestational Age; Health aspects; Hospitals; Humans; Hydrocortisone; Hypotension; Hypotension - diagnosis; Hypotension - therapy; Infant, Newborn; Infant, Premature, Diseases - diagnosis; Infant, Premature, Diseases - therapy; Infant, Very Low Birth Weight; Infants; Infants (Premature); Intensive care; Intensive care units; Intensive Care Units, Neonatal; Low birth weight; Measurement; Medical diagnosis; Neonates; Neonatology - methods; Questionnaires; Reference Values; Steroids; Surveys and Questionnaires; Therapeutic applications; Variation; Weight; Canada
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/sj.jp.7211579

The diagnosis and management of hypotension in the very low birth weight (VLBW) is a controversial area. To establish if there is any consensus in the diagnostic criteria and therapeutic interventions in the hypotensive VLBW among neonatologists in Canada. A postal questionnaire was sent to neonatologists in all level II and III neonatal intensive care units throughout Canada. In total, 120 questionnaires were sent. Ninety-five completed questionnaires were returned. Seventy-six percent of respondents work in units where at least 50 VLBWs and 43% where at least 100 VLBWs are cared for annually. Fifty-seven percent of the respondents have at least 10 years experience as practicing neonatologists. 25.8% rely on blood pressure values alone when intervening, the most common being a blood pressure less than gestational age in weeks. Ninety-seven percent of respondents commence therapy with a fluid bolus. Normal saline is the predominant volume administered (95%). Dopamine remains the pressor of choice. Great variation exists in starting doses and total amount administered. Similar variation exists with epinephrine, with tenfold differences in starting doses (0.01-0.1 mcg/kg/min) and tenfold differences in maximum dose (0.4-4 mc/kg/min) administered. Steroid doses used ranged from 0.1 mg/kg/dose of hydrocortisone to 5 mg/kg/dose. Bicarbonate is rarely used. Three predominant therapeutic regimes exist. These include (i) volume followed by dopamine then a steroid (32%), (ii) volume, dopamine, dobutamine (29%), (iii) volume, dopamine, epinephrine (22%). This is the first large study of practices among neonatologists addressing hypotension in the VLBW infant. There is wide variation in practice, which is a reflection of the lack of good evidence currently available for this very common problem.