pituitrin and Fetal-Distress

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

A deleterious fetal stress response, although not fully elucidated, may account for poor outcomes after experimental fetal cardiac surgery. We set out to characterize this fetal stress response and its potential role in placental dysfunction.. Fifteen ovine fetuses at gestational day 100 to 114 were placed on extracorporeal support for 30 minutes and were then followed 2 hours after cardiopulmonary bypass. Fetal plasma samples were analyzed for vasopressin, cortisol, and beta-endorphin levels, and correlated to fetal hemodynamics and placental gas exchange.. Unique temporal patterns of response were seen in release of the three stress hormones. Vasopressin demonstrated the most profound and early response followed by cortisol and beta-endorphin, the latter continuing to rise in the post-bypass period. A sharp rise in fetal mean arterial pressure and placental vascular resistance strongly correlated with rising vasopressin levels. Post-bypass deterioration of fetal gas exchange and hemodynamics correlated with the ensuing rise in cortisol and beta-endorphin. Rising fetal lactate levels correlated with elevations in all three stress hormones.. Fetal cardiopulmonary bypass leads to a profound, early rise in vasopressin concentrations that strongly correlates with placental dysfunction after fetal bypass. Vasopressin may play an important mechanistic role in pathogenesis of this placental dysfunction.

Topics: Acid-Base Equilibrium; Animals; beta-Endorphin; Carbon Dioxide; Cardiopulmonary Bypass; Female; Fetal Distress; Fetoscopy; Heart Defects, Congenital; Hemodynamics; Hydrocortisone; Lactic Acid; Maternal-Fetal Exchange; Oxygen; Placenta; Pregnancy; Sheep; Sternum; Vascular Resistance; Vasopressins

Topics: Animals; beta-Endorphin; Cardiopulmonary Bypass; Female; Fetal Distress; Fetoscopy; Heart Defects, Congenital; Hydrocortisone; Lactic Acid; Maternal-Fetal Exchange; Placenta; Pregnancy; Sheep; Sternum; Vasopressins

Topics: Acidosis; Female; Fetal Distress; Humans; Hypoxia; Pregnancy; Vasopressins