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Inotropes for Preterm Infants: 50 Years on Are We Any Wiser?

机译:早产儿的正性肌力药:50年以来我们还更聪明吗?

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For almost half a century, inotropes have been administered to preterm infants with the ultimate goal of increasing their blood pressure. A number of trials, the majority of which focused on dopamine administration, have demonstrated increased blood pressure following inotrope administration in preterm infants and have led to continued use of inotropes in our neonatal units. We have also seen an increase in the number of potential agents available to the clinician. However, we now know that hypotension is a much broader concept than blood pressure alone, and our aim should instead be focused on improving end organ perfusion, specifically cerebral perfusion. Only a limited number of studies have incorporated the organ-relevant hemodynamic changes and long-term outcomes when assessing inotropic effects in neonates, the majority of which are observational studies or have a small sample size. In addition, important considerations, including the developing/maturing adrenergic receptors, polymorphisms of these receptors, and other differences in the pharmacokinetics and pharmacodynamics of preterm infants, are only recently being recognized. Certainly, there remains huge variation in practice. The lack of well-conducted randomized controlled trials addressing these relevant outcomes, along with the difficulty executing such RCTs, leaves us with more questions than answers. This review provides an overview of the various inotropic agents currently being used in the care of preterm infants, with a particular focus on their organ/cerebral hemodynamic effects both during and after transition.
机译:近半个世纪以来,一直向早产儿服用正性肌力药,其最终目的是增加血压。许多试验(其中大部分集中在多巴胺给药上)已经证明早产儿服用正性肌力药物后血压升高,并导致我们的新生儿病房继续使用正性肌力药。我们还发现临床医生可以使用的潜在药物数量有所增加。但是,我们现在知道,低血压是一个比单纯的血压更广泛的概念,我们的目标应该集中在改善终末器官灌注,特别是脑灌注。在评估新生儿的正性肌力作用时,只有有限的研究纳入了与器官相关的血液动力学变化和长期结果,其中大多数是观察性研究或样本量较小。此外,重要的考虑因素,包括正在发育/成熟的肾上腺素能受体,这些受体的多态性以及早产儿药代动力学和药效学的其他差异,直到最近才被认识到。当然,实践中仍然存在巨大差异。缺乏针对这些相关结果的进行良好的随机对照试验,加上执行此类随机对照试验的困难,使我们面临的问题多于答案。这篇综述概述了目前在早产儿护理中使用的各种正性肌力药,特别着重于它们在过渡期间和之后的器官/大脑血液动力学效应。

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