pituitrin and Asphyxia-Neonatorum

There is a distinct lack of age-appropriate cardiotonic drugs, and adult derived formulations continue to be administered, without evidence-based knowledge on their dosing, safety, efficacy, and long-term effects. Dopamine remains the most commonly studied and prescribed cardiotonic drug in the neonatal intensive care unit (NICU), but evidence of its effect on endorgan perfusion still remains. Unlike adult and pediatric critical care, there are significant gaps in our knowledge on the use of various cardiotonic drugs in various forms of circulatory failure in the NICU.

Topics: Adrenal Cortex Hormones; Asphyxia Neonatorum; Cardiotonic Agents; Dobutamine; Dopamine; Heart Defects, Congenital; Humans; Hypotension; Infant, Newborn; Intensive Care Units, Neonatal; Milrinone; Neonatal Sepsis; Norepinephrine; Persistent Fetal Circulation Syndrome; Shock; Simendan; Vasoconstrictor Agents; Vasopressins

Epinephrine remains the primary vasopressor for neonatal resuscitation complicated by asystole or prolonged bradycardia not responsive to adequate ventilation and chest compressions. Epinephrine increases coronary perfusion pressure primarily through peripheral vasoconstriction. Current guidelines recommend intravenous epinephrine administration (0.01-0.03 mg/kg). Endotracheal epinephrine administration results in unpredictable absorption. High-dose intravenous epinephrine poses additional risks and does not result in better long-term survival. Vasopressin has been considered an alternative to epinephrine in adults, but there is insufficient evidence to recommend its use in newborn infants. Future research will focus on the best sequence for epinephrine administration and chest compressions.

Topics: Asphyxia Neonatorum; Epinephrine; Female; Fetal Distress; Heart Arrest; Heart Massage; Hemodynamics; Humans; Infant, Newborn; Practice Guidelines as Topic; Pregnancy; Resuscitation; Vasoconstrictor Agents; Vasopressins

Medications are used rarely in newborn resuscitations and are probably justifiable in less than 0.1% of births. Doses used are mainly extrapolated from animal and adult data. Despite this, the drugs used, their order and route of administration have all been sources of controversy for many years. There have been polarised views, often focusing upon adrenaline and sodium bicarbonate and more recently new drugs such as vasopressin have been suggested, once again extrapolating from adult experience. This article examines the sparse data behind the use of any medication at birth and the poor outcome data available. The appropriate decline in the indiscriminate use of volume expansion is considered and balanced by the increasing evidence in favour of delayed clamping of the umbilical cord. Focusing on the basic steps of resuscitation, improving the quality of their application and avoiding relative hypovolaemia, must improve the quality of outcome data. The place of medications in newborn resuscitation should be regarded as experimental and still requires evidence to justify their use especially in premature babies.

Topics: Asphyxia Neonatorum; Blood Transfusion; Blood Volume; Bronchodilator Agents; Contraindications; Delivery Rooms; Epinephrine; Female; Glucose; Humans; Infant, Newborn; Placenta; Pregnancy; Resuscitation; Sodium Bicarbonate; Sweetening Agents; Vasoconstrictor Agents; Vasopressins

Aldosterone, vasopressin (AVP) and atrial natriuretic factor (ANF) plasmatic concentrations were determined in cord arterial blood from 42 newborns to term: 29 healthful and 13 with perinatal asphyxia. Control group showed plasmatic levels (pg/dl) AVP, aldosterone and ANF significantly lower than perinatal asphyxia newborns group (AVP: 2.27 +/- 1.43 vs 4.26 +/- 2.86; aldosterone: 1.113 +/- 384.79 vs 1,540.38 +/- 595.96; ANF: 2.27 +/- 1.43 vs 4.26 +/- 2.86, respectively (p less than 0.05). We found an inverse correlation between umbilical arterial pH vs AVP, aldosterone and AFN, and a direct correlation between ANF vs aldosterone. Perinatal asphyxia induces secretion of the three studied hormonal factors, likely as a physiologic mechanism of fetal adaptation to hydroelectrolytic and hemodynamic changes which occur during the asphyxia.

Topics: Aldosterone; Asphyxia Neonatorum; Atrial Natriuretic Factor; Female; Fetal Blood; Humans; Infant, Newborn; Pregnancy; Vasopressins

Cardiovascular dysfunction in asphyxiated neonates contributes significantly to their morbidity and mortality. We have recently shown that a low-dose vasopressin infusion (0.005 - 0.01 units/kg per hour) may improve myocardial oxygen transport balance in a swine model of neonatal hypoxia-reoxygenation. We aimed to compare the systemic and regional hemodynamic effects of low-dose vasopressin to dobutamine, a synthetic beta-adrenoreceptor agonist. Piglets (1 - 5 days old, 1.6 - 2.2 kg) were anesthetized and instrumented to continuously monitor systemic hemodynamic parameters, including cardiac output and mesenteric flow indices. After 2 h of hypoxia (10% - 15% O2), piglets had normoxic reoxygenation for 4 h. In a blinded randomized fashion, piglets received infusion of either vasopressin (0.01 units/kg per hour started at 30 min of reoxygenation) or dobutamine (20 μg/kg per minute started at 2 h of reoxygenation) (n = 8 per group). Hypoxia-reoxygenation controls (placebo, n = 8) and sham-operated (n = 5) piglets were also studied. Tissue lactate, glutathione, glutathione disulfide, and lipid hydroperoxides levels and histology of the left ventricle and the small bowel were analyzed. Plasma was also analyzed for troponin-I and intestinal fatty acid-binding protein levels. Piglets subjected to hypoxia-reoxygenation had cardiogenic shock and metabolic acidosis, which improved on reoxygenation. During recovery, cardiac output and mesenteric flows gradually deteriorated and were increased similarly in vasopressin- and dobutamine-treated piglets (P < 0.05 vs. controls). Plasma troponin-I and left ventricular lactate levels were lower in the vasopressin and dobutamine groups (P < 0.05 vs. controls), with no difference in the histological analysis among groups. The intestinal GSSG/GSH ratio and lipid hydroperoxides level were lower in the vasopressin and dobutamine groups (P < 0.05 vs. controls). This study is the first to demonstrate that a low-dose vasopressin infusion used in the setting of neonatal swine model of hypoxia-reoxygenation is associated with an improvement in cardiac output and mesenteric perfusion.

Topics: Animals; Animals, Newborn; Asphyxia Neonatorum; Cardiac Output; Dobutamine; Glutathione; Heart Ventricles; Hypoxia; Lactic Acid; Lipid Peroxides; Mesenteric Artery, Superior; Oxygen; Reperfusion Injury; Shock, Cardiogenic; Swine; Troponin I; Vasopressins

Vasopressin in cerebrospinal fluid has been measured in 27 fullterm newborns with hypoxic-ischemic encephalopathy. These newborns were divided into three groups according to the degree of neurological involvement, and they have been compared with a control group of 10 newborns. Determinations of vasopressin in cerebrospinal fluid and plasma were done by RIA. The cerebrospinal fluid vasopressin in asphyxiated newborns was higher than in the control group (p < 0.001); the mean concentration in the group of newborns classified as moderate or severe hypoxic-ischemic encephalopathy was higher than in the control group (18.7 pg/ml vs 4.66 pg/ml), and also higher than in the group classified as mild (14.2 pg/ml). Cerebrospinal fluid vasopressin values have a direct relationship to the plasmatic values at 12 hours of life (r = 0.76; p < 0.001). We concluded that vasopressin values in cerebrospinal fluid at 12 hours increase according to the clinical severity of the neonatal hypoxic-ischemic encephalopathy and that they have a strong relationship with plasmatic vasopressin.

Topics: Asphyxia Neonatorum; Brain Diseases; Brain Ischemia; Gestational Age; Humans; Hypoxia; Infant, Newborn; Vasopressins

The concentrations of aldosterone, vasopressin and plasma renin activity were measured in cord blood and on days 1, 3 and 5 of life in 71 newborn infants from the risk group at the development of critical conditions. Vasopressin was discovered to play a substantial role in the development of critical conditions. The lack of a considerable vasopressin ejection in response to a delivery trouble and the growth of its concentration by day 5 of life are prognostically unfavourable. Hyperactivity of the renin-aldosterone system determines the newborns' proneness to liquid and sodium retention.

Topics: Aldosterone; Asphyxia Neonatorum; Female; Fetal Blood; Hernia, Diaphragmatic; Homeostasis; Humans; Infant, Newborn; Male; Renin; Respiratory Distress Syndrome, Newborn; Vasopressins

To assess the value of cord plasma arginine vasopressin (AVP), erythropoietin (EP), and hypoxanthine (HX) as indices of asphyxia, we studied 62 infants of mothers with preeclampsia, 34 acutely asphyxiated infants, with 5-min Apgar score less than or equal to 6 and/or umbilical arterial pH less than or equal to 7.05, and 38 control infants. Umbilical arterial AVP in the asphyxia group (geometric mean; 95% confidence interval: 180; 92-350 pg/ml) was higher than in the control group (23; 8-66, p = 0.002) and correlated with umbilical arterial pH (r = -0.447, p = 0.028). AVP levels in the preeclampsia group did not differ from controls. Cord venous EP was higher in infants delivered by elective cesarean section from women with severe preeclampsia (115; 75-177 mU/ml, p less than 0.001) than in control infants (23; 18-27); in the whole group EP correlated with pH (r = -0.493, p less than 0.001). EP in the asphyxia group was similar (46; 35-65) to controls (40; 33-47) and did not correlate with pH. Cord arterial HX in the preeclampsia group was similar to controls (12.3; 9.5-16.0 mumol/liter), but elevated in the asphyxia group (23.7; 17.6-31.8, p = 0.001), in which HX correlated with pH (r = 0.558, p = 0.008) and AVP (r = 0.588, p = 0.005). EP did not correlate with AVP or HX in any group, nor did any of the variables correlate with the Apgar score. We conclude that cord plasma AVP and HX reflect acute asphyxia, whereas EP is elevated after more prolonged hypoxia.

Topics: Apgar Score; Asphyxia Neonatorum; Erythropoietin; Female; Fetal Blood; Humans; Hydrogen-Ion Concentration; Hypoxanthine; Hypoxanthines; Infant, Newborn; Male; Pre-Eclampsia; Pregnancy; Vasopressins

Topics: Adolescent; Asphyxia Neonatorum; Brain; Brain Edema; Female; Humans; Hyponatremia; Hypoxia, Brain; Infant, Newborn; Ischemia; Male; Vasopressins

Topics: Adolescent; Asphyxia Neonatorum; Diabetes Insipidus; Female; Humans; Infant, Newborn; Male; Pituitary Gland, Posterior; Pregnancy; Vasopressins

Topics: Age Factors; Arginine; Asphyxia Neonatorum; Birth Weight; Female; Humans; Infant Food; Infant, Newborn; Infant, Premature; Kidney; Kidney Concentrating Ability; Male; Osmolar Concentration; Urine; Vasopressins

Topics: Asphyxia Neonatorum; Humans; Hypertonic Solutions; Hyponatremia; Infant, Newborn; Male; Meningitis; Osmolar Concentration; Osmosis; Punctures; Sodium; Sodium Chloride; Urine; Vasopressins