Eiby Yvonne A, Shrimpton Nicole Y, Wright Ian M R, Lumbers Eugenie R, Colditz Paul B, Duncombe Greg J, Lingwood Barbara E
UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia.
Perinatal Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia.
Pediatr Res. 2016 Dec;80(6):870-879. doi: 10.1038/pr.2016.156. Epub 2016 Aug 4.
The preterm newborn is at high risk of developing cardiovascular compromise during the first day of life and this is associated with increased risk of brain injury. Standard treatments are volume expansion and administration of inotropes, typically dopamine and/or dobutamine, but there is limited evidence that inotropes improve clinical outcomes. This study investigated the efficacy of dopamine and dobutamine for the treatment of cardiovascular compromise in the preterm newborn using a piglet model.
Preterm and term piglets were assigned to either dopamine, dobutamine or control infusions. Heart rate, left ventricular contractility, cardiac output, blood pressure, and cerebral and regional blood flows were measured during baseline, low (10 µg/kg/h), and high (20 µg/kg/h) dose infusions.
At baseline, preterm piglets had lower cardiac contractility, cardiac output, blood pressure, and cerebral blood flow compared to term piglets. The response of preterm piglets to either dopamine or dobutamine administration was less than in term piglets. In both preterm and term piglets, cardiac output and cerebral blood flow were unaltered by either inotrope.
In order to provide better cardiovascular support, it may be necessary to develop treatments that target receptors with a more mature profile than adrenoceptors in the preterm newborn.
早产新生儿在出生后第一天发生心血管功能不全的风险很高，这与脑损伤风险增加有关。标准治疗方法是扩容和使用血管活性药物，通常是多巴胺和/或多巴酚丁胺，但证据有限，表明血管活性药物能改善临床结局。本研究使用仔猪模型研究多巴胺和多巴酚丁胺治疗早产新生儿心血管功能不全的疗效。
将早产和足月仔猪分为多巴胺组、多巴酚丁胺组或对照组进行输注。在基线、低剂量（10μg/kg/h）和高剂量（20μg/kg/h）输注期间测量心率、左心室收缩力、心输出量、血压以及脑血流和局部血流。
在基线时，与足月仔猪相比，早产仔猪的心脏收缩力、心输出量、血压和脑血流较低。早产仔猪对多巴胺或多巴酚丁胺给药的反应小于足月仔猪。在早产和足月仔猪中，两种血管活性药物均未改变心输出量和脑血流。
为了提供更好的心血管支持，可能有必要开发针对比早产新生儿肾上腺素能受体更成熟的受体的治疗方法。
