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 PCO(2) 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.