Observational Study of Cerebral Hemodynamics during Dopamine Treatment in Hypotensive ELBW Infants on the First Day of Life

Objective—To evaluate cerebral hemodynamics during dopamine treatment in hypotensive (mean arterial blood pressure [MABP] < gestational age) ELBW infants. Study Design—Continuous monitoring of cerebral blood flow velocity (CBFv), MABP, and PCO2 was performed in hypotensive ELBW infants on the first day of life, beginning with ~15 min baseline reading and continued during advancing dopamine infusion until MABP was optimized. Physiologic variables and CBFv reactivity were compared before and after MABP was optimized. Result—Fifteen hypotensive ELBW infants (625 ± 174 g; 24 [23 to 24.8] weeks) were studied. Mean CBFv increased from 10.9 ± 3.7 to 15.7 ± 5.7 cm/s (P=0.001) simultaneously as MABP increased from 22.3 ± 2.8 to 35.2 ± 9.7 mm Hg (P<0.001). Mean CBFv reactivity (95 % CI) was 3.9 (1.6 to 6.2) %∙mm Hg−1. Nine infants died and/or developed severe intraventricular hemorrhage (IVH). Conclusion—Mean CBFv increased pressure-passively as MABP was optimized by dopamine treatment in very sick hypotensive ELBW infants on the first day of life