The use of a calcium-channel blocker, nicardipine, for severely asphyxiated newborn infants.

A continuous infusion of nicardipine was given to four severely asphyxiated fullterm infants who were at high risk for adverse outcome and had abnormal cerebral Doppler haemodynamic studies. The heart rate increased in all four infants and mean arterial blood pressure (MAP) fell in three. Two infants had a sudden and marked fall in MAP, together with severe impairment of skin blood-flow and a concurrent fall in cerebral blood-flow velocity. The serum level of nicardipine was less than 40ng/mL in all cases. The use of nicardipine, and possibly other calcium-channel blockers, may be associated with marked hypotension, and if there is no cerebral autoregulation, may cause further cerebral hypoperfusion, so use of these drugs in asphyxiated newborn infants should only be attempted if blood pressure is carefully monitored.