Filippi Luca, Pezzati Marco, Cecchi Alessandra, Serafini Lisa, Poggi Chiara, Dani Carlo, Tronchin Michele, Seminara Salvatore
Neonatal Intensive Care Unit, Department of Critical Care Medicine, University Careggi Hospital, Florence, Italy.
Biol Neonate. 2006;89(4):274-80. doi: 10.1159/000091741. Epub 2006 Feb 23.
Previous studies demonstrated that dopamine infusion reduces plasma concentration of thyroxine (T4), thyroid stimulating hormone (TSH), prolactin (PRL), and growth hormone (GH) in adults, children, and infants.
The purpose of this prospective observational study was to evaluate the relationship between dopamine infusion and the dynamics of T4, TSH, PRL, and GH in preterm newborns weighing less than 1,500 g (very low birth weight infants, VLBW) admitted in a neonatal intensive care unit of a university hospital over a one year period.
A total of 97 preterm newborns were enrolled and divided into two groups: group B included hypotensive infants treated with plasma expanders and dopamine infusion; group A was the control group including newborns who were never treated with dopamine. The newborns were studied dynamically through blood samples taken every day till 10 days. Newborns of group B were studied during dopamine infusion and after its withdrawal.
Among the VLBW newborns who were given dopamine, the four pituitary hormones had different dynamics: a reduction of T4, TSH, and PRL levels was noticed since the first day of treatment, and a rebound of their levels was evident since the first day after its interruption. On the contrary, the postprandial GH levels were roughly constant: GH plasma concentrations were in fact a little lower in newborns treated with dopamine, and a slight increase was observed after its withdrawal. However, observed differences were not statistically significant.
The results suggest that dopamine infusion reduces T4, TSH, and PRL plasma levels in preterm VLBW infants and have no effect on postprandial GH rate. This hormonal suppression reverses rapidly after dopamine withdrawal. This observation suggests that the iatrogenic pituitary suppression probably cannot produce long-term injuries.
先前的研究表明，多巴胺输注可降低成人、儿童和婴儿的血浆甲状腺素（T4）、促甲状腺激素（TSH）、催乳素（PRL）和生长激素（GH）浓度。
这项前瞻性观察研究的目的是评估在一所大学医院的新生儿重症监护病房住院的1年内体重小于1500g的早产新生儿（极低出生体重儿，VLBW）中，多巴胺输注与T4、TSH、PRL和GH动态变化之间的关系。
共纳入97例早产新生儿，分为两组：B组为接受血浆扩容剂和多巴胺输注治疗的低血压婴儿；A组为对照组，包括从未接受过多巴胺治疗的新生儿。每天采集血样，对新生儿进行动态研究，直至第10天。对B组新生儿在多巴胺输注期间及其停用后进行研究。
在接受多巴胺治疗的VLBW新生儿中，四种垂体激素有不同的动态变化：自治疗第一天起，T4、TSH和PRL水平降低，自中断治疗第一天起其水平明显反弹。相反，餐后GH水平大致恒定：实际上，接受多巴胺治疗的新生儿的GH血浆浓度略低，停用后略有升高。然而，观察到的差异无统计学意义。
结果表明，多巴胺输注可降低早产VLBW婴儿的T4、TSH和PRL血浆水平，对餐后GH水平无影响。多巴胺停用后，这种激素抑制作用迅速逆转。这一观察结果表明，医源性垂体抑制可能不会造成长期损伤。
